[1]王 伟,宫秀群,余 亮.阿替普酶治疗急性脑梗死患者临床转归的影响因素[J].医学信息,2022,35(11):84-88.[doi:10.3969/j.issn.1006-1959.2022.11.022]
 WANG Wei,GONG Xiu-qun,YU Liang.The Influencing Factors of Clinical Outcome in Patients with Acute Cerebral Infarction Treated with Alteplase[J].Medical Information,2022,35(11):84-88.[doi:10.3969/j.issn.1006-1959.2022.11.022]
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阿替普酶治疗急性脑梗死患者临床转归的影响因素()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年11期
页码:
84-88
栏目:
论著
出版日期:
2022-06-01

文章信息/Info

Title:
The Influencing Factors of Clinical Outcome in Patients with Acute Cerebral Infarction Treated with Alteplase
文章编号:
1006-1959(2022)11-0084-05
作者:
王 伟宫秀群余 亮
(1.南京大学医学院附属盐城第一医院/盐城市第一人民医院神经内科,江苏 盐城 224001;2.淮南市第一人民医院神经内科,安徽 淮南 232001)
Author(s):
WANG WeiGONG Xiu-qunYU Liang
(1.Department of Internal Neurology,Yancheng First Hospital,Affiliated Hospital of Nanjing University Medical School/the First People’s Hospital of Yancheng,Yancheng 224001,Jiangsu,China;2.Department of Internal Neurology,the First People’s Hospital of
关键词:
急性脑梗死阿替普酶静脉溶栓溶栓时间窗
Keywords:
Acute cerebral infarctionAlteplaseIntravenous thrombolysisThrombolytic time window
分类号:
R743.3
DOI:
10.3969/j.issn.1006-1959.2022.11.022
文献标志码:
A
摘要:
目的 探讨急性脑梗死患者阿替普酶静脉溶栓治疗后转归的影响因素。方法 选取2018年10月-2019年9月淮南市第一人民医院神经内科收治的急性脑梗死患者139例作为研究对象,均于发病4.5 h内接受阿替普酶溶栓,根据发病3个月后临床转归情况分为转归良好组和转归不良组。采用单因素及多因素Logistic回归分析影响影响阿替普酶溶栓临床转归的独立危险因素。结果 有71例患者转归良好,68例转归不良。两组年龄、收缩压、随机血糖、空腹血糖、中性粒细胞计数、基线NIHSS评分、溶栓时间窗比较,差异有统计学意义(P<0.05);多变量Logistic回归分析显示,基线NIHSS评分(OR:1.495,95%CI:1.303~1.715,P=0.000)、空腹血糖(OR:1.369,95%CI:1.052~1.775,P=0.018)、中性粒细胞计数(OR:1.264,95%CI:1.016~1.573,P=0.035)是影响阿替普酶溶栓临床转归的独立危险因素。结论 基线NIHSS评分、空腹血糖、中性粒细胞计数与急性脑梗死阿替普酶溶栓治疗的临床转归密切相关。
Abstract:
Objective To investigate the influencing factors of outcome after intravenous thrombolysis with alteplase in patients with acute cerebral infarction.Methods A total of 139 patients with acute cerebral infarction admitted to the Department of Neurology, the First People’ s Hospital of Huainan from October 2018 to September 2019 were selected as the research objects. All patients received alteplase thrombolysis within 4.5 h of onset. According to the clinical outcome after 3 months of onset, they were divided into good outcome group and poor outcome group. Single factor and multiple factor logistic regression analysis were used to analyze the independent risk factors affecting the clinical outcome of alteplase thrombolysis.Results There were 71 patients with good outcome and 68 patients with poor outcome. There were statistically significant differences in age, systolic blood pressure, random blood glucose, fasting blood glucose, neutrophil count, baseline NIHSS score thrombolytic time window between the two groups (P<0.05). Multivariate logistic regression analysis showed that baseline NIHSS score (OR:1.495, 95%CI:1.303-1.715, P=0.000 ), fasting blood glucose (OR:1.369, 95%CI:1.052-1.775, P=0.018), neutrophil count (OR:1.264, 95%CI:1.016-1.573, P=0.035) were independent risk factors affecting the clinical outcome of alteplase thrombolysis.Conclusion The baseline NIHSS score, fasting blood glucose and neutrophil count are closely related to the outcome of thrombolytic therapy with alteplase for acute cerebral infarction.

参考文献/References:

[1]Wang W,Jiang B,Sun H,et al.Prevalence,Incidence, and Mortality of Stroke in ChinaClinical Perspective:Results from a Nationwide Population-Based Survey of 480687 Adults[J].Circulation,2017,135(8):759.[2]Whiteley WN,Emberson J,Lees KR,et al.Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis[J].Lancet Neurology,2016,15(9):925-933.[3]Mistry EA,Yeatts S,de Havenon A,et al.Predicting 90-Day Outcome After Thrombectomy: Baseline-Adjusted 24-Hour NIHSS Is More Powerful Than NIHSS Score Change[J].Stroke,2021,52(8):2547-2553.[4]Eskioglou E,Huchmandzadeh Millotte M,Amiguet M,et al.National Institutes of Health Stroke Scale Zero Strokes[J].Stroke,2018,49(12):3057-3059.[5]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志,2018,51(9):666-682.[6]董漪,董强.中国急性缺血性卒中静脉溶栓现状[J].中国实用内科杂志,2018,38(8):685-688.[7]马灿灿,张熙斌,李晓波,等.高龄急性脑梗死患者阿替普酶静脉溶栓有效性、安全性及预后影响因素分析[J].中国卒中杂志,2020,15(9):972-977.[8]Virani SS,Alonso A,Benjamin EJ,et al.Heart Disease and Stroke Statistics-2020 Update:A Report From the American Heart Association[J].Circulation,2020,141(9):e139-e596.[9]Muruet W,Rudd A,Wolfe CDA,et al.Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke:A Propensity Score-Matched Cohort With up to 10-Year Follow-Up[J].Stroke,2018,49(3):607-613.[10]Roy-O’Reilly M,McCullough LD.Age and Sex Are Critical Factors in Ischemic Stroke Pathology[J].Endocrinology,2018,159(8):3120-3131.[11]盘爱花,李其富,邝小玲,等.血压监测及降压干预对急性脑梗死静脉溶栓患者预后的影响[J].贵州医科大学学报,2020,45(9):1072-1076.[12]Verschoof MA,Groot AE,Vermeij JD,et al.Association Between Low Blood Pressure and Clinical Outcomes in Patients With Acute Ischemic Stroke[J].Stroke,2020,51(1):338-341.[13]Lobanova I,Qureshi AI.Blood Pressure Goals in Acute Stroke—How Low Do You Go?[J].Current Hypertension Reports,2018,20(4):1-9.[14]Bangalore S,Schwamm L,Smith EE,et al.Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke[J].European Heart Journal,2017(37):2827-2835.[15]陆闽侨,李碧澄,田野,等.血细胞对动脉粥样硬化出血斑块炎症环境及转归的影响[J].中国动脉硬化杂志,2021,29(9):819-824.[16]Kang L,Yu H,Yang X,et al.Neutrophil extracellular traps released by neutrophils impair revascularization and vascular remodeling after stroke[J].Nat Commun,2020,11(1):2488-2502.[17]方美凤,谭峰,王学文.细胞因子信号转导抑制因子3和白三烯B4及白细胞介素6与脑梗死体积的相关性[J].中华老年心脑血管病杂志,2018,20(10):1095-1096.[18]王静悦,王杰,陶怡凝,等.应激性高血糖及白细胞计数升高对急性脑梗死近期预后的影响[J].中国临床研究,2020,33(5):623-625,629[19]Sch?觟bitz WR,Minnerup J.Neutrophils in Acute Stroke Pathophysiology[J].Stroke,2019,50(3):e44-e45.[20]Deng J,Zhao F,Zhang Y,et al.Neutrophil extracellular traps increased by hyperglycemia exacerbate ischemic brain damage[J].Neurosci Lett,2020,738:135383.[21]Guo Z,Yu S,Chen X,et al.Suppression of NLRP3 attenuates hemorrhagic transformation after delayed rtPA treatment in thromboembolic stroke rats: Involvement of neutrophil recruitment[J].Brain Res Bull,2018,137:229-240.[22]Winneberger J,Sch?觟ls S,Lessmann K,et al.Platelet endothelial cell adhesion molecule-1 is a gatekeeper of neutrophil transendothelial migration in ischemic stroke[J].Brain Behav Immun,2021,93:277-287.[23]Mi D,Wang P,Yang B,et al.Correlation of hyperglycemia with mortality after acute ischemic stroke[J].Ther Adv Neurol Disord,2018,11:1756285617731686.[24]Palaiodimou L,Lioutas VA,Lambadiari V,et al.Glycemia management in acute ischemic stroke: current concepts and novel therapeutic targets[J].Postgrad Med,2019,131(7):423-437.[25]张晓丽,崔焜焱,姚建华.糖尿病并发急性脑梗死的多靶点机制分析[J].中国实验诊断学,2019,23(1):151-154.[26]Pektas MB,Turan O,Bingol GO,et al.High glucose causes vascular dysfunction through Akt/eNOS pathway: reciprocal modulation by juglone and resveratrol[J].Can J Physiol Pharmacol,2018,96(8):757-764.[27]Haidara MA,Al-Ani B,Bin-Jaliah I,et al.Vanadyl sulphate ameliorates biomarkers of endothelial injury and coagulation and thrombosis in a rat model of hyperglycaemia[J].Arch Physiol Biochem,2022,128(2):447-454.[28]Cerecedo-Lopez CD,Cantu-Aldana A,Patel NJ,et al.Insulin in the Management of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis[J].World Neurosurg,2020,136:e514-e534.

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更新日期/Last Update: 1900-01-01