腦白質(zhì)疏松程度與急性腦梗死患者靜脈溶栓治療后癥狀性腦出血轉(zhuǎn)化的相關(guān)性研究
發(fā)布時(shí)間：2018-09-01 14:07
【摘要】：目的探討腦白質(zhì)疏松(LA)程度與急性腦梗死患者靜脈應(yīng)用重組人組織型纖溶酶原激活劑(rt-PA)溶栓治療后癥狀性腦出血(sICH)轉(zhuǎn)化的相關(guān)性。方法連續(xù)選取急性頸內(nèi)動(dòng)脈系統(tǒng)腦梗死患者117例,符合溶栓治療指征者采用靜脈rt-PA以0.9 mg/kg足量溶栓治療,其余則給予普通安慰劑治療。所有患者根據(jù)Wahlund改良LA分級(jí)量表(ARWMC)評(píng)分對(duì)LA嚴(yán)重程度進(jìn)行分級(jí):輕度(1~5分),中度(6~10分),重度(10分)。溶栓后24~36 h復(fù)查頭CT,判定是否出現(xiàn)sICH轉(zhuǎn)化。比較不同程度LA患者中溶栓組和安慰劑組sICH轉(zhuǎn)化率。結(jié)果本研究組中,溶栓治療者49例,安慰劑使用者68例;LA輕度45例,LA中度25例,LA重度47例。本研究共有10例患者(8.5%)發(fā)生s ICH轉(zhuǎn)化,其中溶栓治療者7例,安慰劑使用者3例;LA輕度2例,LA中度2例,LA重度6例。在LA輕度及中度患者中,溶栓組患者sICH轉(zhuǎn)化率略高于較安慰劑組(P=0.052,P=0.650)。而在LA重度患者中,溶栓組患者s ICH轉(zhuǎn)化率明顯高于安慰劑組(P=0.043)。Pearson相關(guān)性分析結(jié)果顯示,溶栓組患者ARWMC評(píng)分與其靜脈溶栓治療后sICH轉(zhuǎn)化率呈正相關(guān)(r=0.476,P=0.0005)。結(jié)論重度LA可增加急性腦梗死患者rt-PA靜脈溶栓后sICH轉(zhuǎn)化的風(fēng)險(xiǎn)。了解患者的LA程度有助于對(duì)臨床溶栓決策的選擇和對(duì)患者預(yù)后的判斷。
[Abstract]:Objective to investigate the correlation between the degree of leukoaraiosis (LA) and the (sICH) transformation in patients with acute cerebral infarction after thrombolytic therapy with recombinant human tissue plasminogen activator (rt-PA). Methods 117 consecutive patients with acute cerebral infarction of internal carotid artery system were selected. The patients who were in accordance with thrombolytic therapy indications were treated with intravenous rt-PA with 0.9 mg/kg adequate thrombolytic therapy and the others were treated with general placebo. The severity of LA was graded according to the (ARWMC) score of Wahlund modified LA scale: mild (1 ~ 5), moderate (6 ~ 10), severe (10). After 24 minutes of thrombolytic therapy, the head CT, was reviewed to determine whether there was sICH transformation or not. SICH conversion rates were compared between thrombolytic group and placebo group in patients with different degrees of LA. Results in this study group, 49 patients were treated with thrombolytic therapy, and 47 patients were treated with placebo as placebo group, with mild LA in 45 cases, moderate LA in 25 cases and severe LA in 47 cases. In this study, 10 patients (8.5%) developed s ICH transformation, including 7 patients with thrombolytic therapy and 3 patients with placebo who had mild LA in 2 patients and moderate LA in 2 patients and severe LA in 6 patients. In mild and moderate LA patients, the sICH conversion rate in thrombolytic group was slightly higher than that in placebo group (P0. 052, P0. 650). In severe patients with LA, the conversion rate of s ICH in thrombolytic group was significantly higher than that in placebo group (P0. 043). Pearson correlation analysis showed that the ARWMC score of thrombolytic group was positively correlated with sICH conversion rate after intravenous thrombolytic therapy (r = 0. 476, P < 0. 0005). Conclusion severe LA can increase the risk of sICH transformation after rt-PA intravenous thrombolysis in patients with acute cerebral infarction. Understanding the degree of LA is helpful to the choice of clinical thrombolytic decision and to the prognosis of patients.
【作者單位】： 大連市第三人民醫(yī)院神經(jīng)內(nèi)科;大連市中心醫(yī)院神經(jīng)內(nèi)科;
【基金】：大連市局衛(wèi)生計(jì)生機(jī)構(gòu)醫(yī)學(xué)科研課題(2013-34)
【分類號(hào)】：R743.3
本文編號(hào)：2217437
[Abstract]:Objective to investigate the correlation between the degree of leukoaraiosis (LA) and the (sICH) transformation in patients with acute cerebral infarction after thrombolytic therapy with recombinant human tissue plasminogen activator (rt-PA). Methods 117 consecutive patients with acute cerebral infarction of internal carotid artery system were selected. The patients who were in accordance with thrombolytic therapy indications were treated with intravenous rt-PA with 0.9 mg/kg adequate thrombolytic therapy and the others were treated with general placebo. The severity of LA was graded according to the (ARWMC) score of Wahlund modified LA scale: mild (1 ~ 5), moderate (6 ~ 10), severe (10). After 24 minutes of thrombolytic therapy, the head CT, was reviewed to determine whether there was sICH transformation or not. SICH conversion rates were compared between thrombolytic group and placebo group in patients with different degrees of LA. Results in this study group, 49 patients were treated with thrombolytic therapy, and 47 patients were treated with placebo as placebo group, with mild LA in 45 cases, moderate LA in 25 cases and severe LA in 47 cases. In this study, 10 patients (8.5%) developed s ICH transformation, including 7 patients with thrombolytic therapy and 3 patients with placebo who had mild LA in 2 patients and moderate LA in 2 patients and severe LA in 6 patients. In mild and moderate LA patients, the sICH conversion rate in thrombolytic group was slightly higher than that in placebo group (P0. 052, P0. 650). In severe patients with LA, the conversion rate of s ICH in thrombolytic group was significantly higher than that in placebo group (P0. 043). Pearson correlation analysis showed that the ARWMC score of thrombolytic group was positively correlated with sICH conversion rate after intravenous thrombolytic therapy (r = 0. 476, P < 0. 0005). Conclusion severe LA can increase the risk of sICH transformation after rt-PA intravenous thrombolysis in patients with acute cerebral infarction. Understanding the degree of LA is helpful to the choice of clinical thrombolytic decision and to the prognosis of patients.
【作者單位】： 大連市第三人民醫(yī)院神經(jīng)內(nèi)科;大連市中心醫(yī)院神經(jīng)內(nèi)科;
【基金】：大連市局衛(wèi)生計(jì)生機(jī)構(gòu)醫(yī)學(xué)科研課題(2013-34)
【分類號(hào)】：R743.3
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