脑梗死急性期血浆组织型纤溶酶原激活物对其预后的影响

目的探讨脑梗死急性期血浆中组织型纤溶酶原激活物（t—PA）水平对脑梗死预后的评估价值。方法采用前瞻性设计，将120例急性脑梗死患者分为t—PA正常组（〉1．3IU／ml）69例和t—PA降低组（≤1．3IU／ml）51例，对两组患者进行生存分析比较。在发病72h内检测血浆t—PA水平，随访1年，将死亡及再发缺血性血管病记录为终点事件。采用多元回归分析，分析t-PA、高血压、糖尿病、冠心病、高血脂、年龄、吸烟、饮酒等因素对终点事件的影响。结果①t-PA降低组患者较t-PA正常组患者终点事件发生率显著增加（28．9％，11．7％；P=0．007，log-rank检验）；②多变量回归分析显示，t-PA降低（OR=3．966；95％CI：1．753-13．285；P=0．039）、吸烟（OR=5．233；95％CI：1．991～16．227；P=0．035）及糖尿病（OR=4786；95％CI：1．591—16．709；P=0．033）与终点事件独立相关。结论脑梗死急性期t-PA降低可能是脑梗死发病1年内死亡和再发缺血性血管病的独立危险因素。

Effect of plasma tissue plasminogen activator on the prognosis of acute cerebral infarction

Objective To investigate the assessment value of tissue plasminogen activator （t-PA） on the prognosis of acute cerebral infarction. Methods One hundred and twenty patients with acute cerebral infarction were divided into t-PA normal group （ 〉 1.3 IU/mL） and t-PA reduced group （ ≤1.3 IU/mL）. The survival rate was compared between the 2 groups. The levels of serum t-PA within 72 hours after onset of cerebral infarction were detected, and the patients were followed up for 12 months. Death and recurrent ischemic cerebrovascular attack were recorded as the final events. The effects of plasma t-PA level, hypertension, diabetes mellitus, coronary heart disease, hyperlipemia, age, smoking, and alcohol use on the final event of cerebral infarction were analyzed by multiple regression analysis. Results The incidence of final events in patients with t-PA reduction as compared with those with t-PA normal were significantly increased （28.9% vs 11.7% ; P = 0. 007, log-rank test）. The multiple regression analysis showed that t-PA reduction （ OR = 3. 966 ; 95% CI 1. 753 - 13. 285, P = 0. 039）, smoking （ OR = 5. 233 ; 95% CI 1. 991 - 16. 227, P = 0. 035） and diabetes mellitus （ OR = 4. 786 ; 95% CI 1. 591 - 16. 709, P = 0. 033 ） were independently correlated with the final events. Conclusion The t-PA reduction in acute phase of cerebral infarction may be an independent risk factor of death and recurrent ischemic cerebrovascular attack within 12 months of former cerebral infarction.