高龄急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓的疗效及安全性分析

目的 探讨高龄脑梗死患者接受标准剂量重组组织型纤溶酶原激活剂（r e c o m b i n a n t t i s s u e plasminogen activator，rt-PA）静脉溶栓治疗的疗效和安全性。 方法 对我院2011年1月～2013年12月连续收治入院的254例急性脑梗死患者的临床资料进行回顾性 分析，分为老龄溶栓组118例（60＜年龄≤80岁，rt-PA静脉溶栓治疗）；高龄溶栓组62例（年龄＞80岁， rt-PA静脉溶栓治疗）；高龄非溶栓组74例（年龄＞80岁，非rt-PA静脉溶栓治疗）。比较3组入院前的 一般情况，溶栓治疗前美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS） 评分，溶栓后出血转化率及治疗7 d内致死性出血率，治疗后90 d改良Rankin量表（modifed Rankin Scale，mRS）评分和90 d的病死率。 结果 老龄溶栓组、高龄溶栓组和高龄非溶栓组治疗前NIHSS评分（13.0±5.3、15.1±6.6、14.1±6.6； P =0.523）无显著差异，3组的急性期事件出血转化率分别为16.9%、20.9%和21.6%，P =0.675；3组 7 d内致死性出血的发生率分别为3.3%，9.6%，7.4%，P =0.20。90 d内的病死率分别为11.0%，22.6%， 16.2%，P =0.12。老龄溶栓组和高龄溶栓组治疗后90 d的mRS评分 0～2比值分别为56.8%和38.7%， 两组比值比（odds ratio，OR）为2.08；95%可信区间（confidence interval，CI）为1.11～3.86，P =0.021；两 组治疗后90 d mRS评分中位数比较：2 vs 3，P =0.025。高龄溶栓组和高龄非溶栓组90 d的mRS评分 0～2比值分别为38.7%和21.6%，OR 1.81，95%CI 0.80～4.06，P =0.098；90 d mRS评分中位数比较：3 vs 5，P =0.008。 结论 与未溶栓的高龄患者相比，急性缺血性卒中老龄和高龄患者接受rt-PA治疗不增加急性期 出血转化率和病死率。老龄组比高龄组rt-PA治疗获益大，高龄溶栓组比非溶栓组获益大。高龄组 rt-PA治疗可以改善患者90 d生活自理能力且不增加病死率。

Analysis of the Effectiveness and Safety of Recombinant Tissue Type Plasminogen Activator Therapy for Elder Patients with Acute Ischemic Stroke

Objective To investigate the safety and effectiveness of recombinant tissue plasminogen activator （rt-PA） therapy without endovascular therapy for acute ischemic stroke （AIS） patients （≥80 years old）. Methods The data were collected from January 2011 to December 2013. Intravenous rt-PA was administered to patients within 4.5 hours of stroke onset. The patients who received rt-PA therapy were stratiifed into two age groups：an old group （n=118,〉60 and〈80 years） and an elder group （n=62, ≥80 years） and the other elder group without rt-PA therapy （n=74, ≥80 years）. The National Institutes of Health Stroke Scale （NIHSS） scores between three groups were compared before thrombolysis. The incidence of hemorrhage transformation （HT）, incidence of fatal intracerebral hemorrhage （ICH） within 7 days, mortality and modiifed Rankin Scale （mRS） score at 90 days were examined. Results There is no difference of NIHSS score between groups （13.0±5.3 vs 15.1±6.6 vs 14.1±6.6;P=0.523）. The incidence of fatal ICH within 7 days was also not significantly different （3.3%vs 9.6%vs 7.4%, P〈0.2）. Odds ratio was 2.08, 95% confidence interval （CI） was 1.11～3.86 for mRS 0 to 2 at 90 days between rt-PA therapy groups （P=0.021）;The median of mRS score was signiifcantly higher 2（1～3） vs 3（1～5）, P=0.025. Odds Ratio was 1.81, 95%CI was 0.8～4.06 between the elder groups with or without rt-PA therapy （P=0.098）. The median of mRS score 3（1～5） vs 5（2～5）, P=0.008. There are no difference of 90-day mortality in the three groups （11%vs 22.6%vs 16.2%;P=0.12）. Conclusion rt-PA therapy appears to be as safe for AIS patients≥80 years as it is for old patients. Elder patients still could beneift from rt-PA therapy, though not as effective as old patients. This therapy should not be withheld because of age.