轻型缺血性卒中TOAST分型及静脉溶栓的研究(1)
[摘要] 目的 评测轻型缺血性卒中TOAST各亚型rt-PA静脉溶栓治疗的安全性和短期预后。 方法 选取承德市中心医院2013年11月～2016年1月收治的256例轻型缺血性卒中患者，其中136例接受rt-PA静脉溶栓(静脉溶栓组)，120例接受口服药物治疗(未溶栓组)，并对两组患者进行TOAST病因分型。治疗90 d后评测NIHSS评分、改良Rankin量表评分(mRS)，其中NIHSS评分0～1分、mRS为0～1分者定义为良好结局，并比较两组患者90 d内脑出血率、死亡率和复发率。 结果 静脉溶栓组患者良好结局的比例明显高于未溶栓组(P < 0.05)，复发率明显低于未溶栓组(P < 0.05)。其中，大动脉粥样硬化型(LAA)亚组患者接受静脉溶栓良好结局的比例明显高于未溶栓者(P < 0.05)，其脑梗死复发率明显降低(P < 0.05)。 结论 rt-PA静脉溶栓治疗可提高轻型缺血性卒中，尤其是LAA型患者90 d内良好结局的比例，减少复发率，安全性可。
[关键词] 轻型缺血性卒中；重组组织型纤溶酶原激活剂；溶栓治疗；TOAST分型
[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210(2017)08(b)-0056-04
[Abstract] Objective To analysis safety and short-term prognosis of rt-PA intravenous thrombolysis treatment in different TOAST subtype of minor ischaemic stroke. Methods From November 2013 to January 2016， 256 patients with mild ischaemic stroke in Chengde Central Hospital were selected. 136 patients were treated with rt-PA intravenous thrombolysis (intravenous thrombolysis group)， and 120 patients were treated with oral drugs (non thrombolysis group)， the patients in the two groups were divided by TOAST etiology. 90 days after treatment， the scores of NIHSS and mRS， the cerebral hemorrhage rate， death rate， recurrence rate were observed， besides the NIHSS score of 0-1 and mRS of 0-1 were defined as good outcomes. Results The proportion of good outcomes in the intravenous thrombolysis group was higher than that of the non thrombolysis group， the recurrence rate was lower than that of the non thrombolysis group， with statistically significant difference (P < 0.05). And the proportion of good outcomes in the LAA subgroup who were treated with rt-PA intravenous thrombolysis was higher and the recurrence rate was lower (P < 0.05). Conclusion rt-PA intravenous thrombolysis can improve the proportion of good outcomes in the patients with minor ischaemic stroke in 90 days， especially LAA subtype， reduce the recurrence rate， and it has good safety.
[Key words] Minor ischaemic stroke； Recombinant tissue plasminogen activator； Thrombolytic therapy； TOAST etiology
急性缺血性腦卒中(acute ischaemic stroke，AIS)的静脉溶栓可以明显降低患者的残疾率和死亡率，能够明显改善患者的预后。因此，对于AIS，目前国际指南已将应用重组人组织型纤溶酶原激活剂(recombinant tissue plasminogen activator，rt-PA)静脉溶栓治疗作为第一推荐，然而仅有1%～5%的患者接受此治疗，在没有接受静脉溶栓治疗的患者中，轻型缺血性卒中(minor ischemic stroke，MIS)及卒中症状快速恢复是其中一个重要的原因[1]。虽然MIS定义不一，一般是指脑卒中后症状较轻，仅仅表现为轻度神经功能缺损的AIS[2]。目前关于MIS的rt-PA静脉溶栓远期预后结论不一致，有研究认为，接受溶栓的MIS患者可以获得好的预后结果[3-5]，也有研究认为，MIS静脉溶栓治疗并不能远期获益[6-8]。因此，承德市中心医院(以下简称“我院”)开展了轻型卒中rt-PA静脉溶栓治疗，将MIS患者进行TOAST病因分型，明确病因后，再与对照组比较，以观察MIS患者接受rt-PA静脉溶栓治疗的效果，同时评估MIS静脉溶栓的安全性。, 百拇医药(朱海暴 杨静 沈永玲 齐丽敏 冯丽 )
[关键词] 轻型缺血性卒中；重组组织型纤溶酶原激活剂；溶栓治疗；TOAST分型
[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210(2017)08(b)-0056-04
[Abstract] Objective To analysis safety and short-term prognosis of rt-PA intravenous thrombolysis treatment in different TOAST subtype of minor ischaemic stroke. Methods From November 2013 to January 2016， 256 patients with mild ischaemic stroke in Chengde Central Hospital were selected. 136 patients were treated with rt-PA intravenous thrombolysis (intravenous thrombolysis group)， and 120 patients were treated with oral drugs (non thrombolysis group)， the patients in the two groups were divided by TOAST etiology. 90 days after treatment， the scores of NIHSS and mRS， the cerebral hemorrhage rate， death rate， recurrence rate were observed， besides the NIHSS score of 0-1 and mRS of 0-1 were defined as good outcomes. Results The proportion of good outcomes in the intravenous thrombolysis group was higher than that of the non thrombolysis group， the recurrence rate was lower than that of the non thrombolysis group， with statistically significant difference (P < 0.05). And the proportion of good outcomes in the LAA subgroup who were treated with rt-PA intravenous thrombolysis was higher and the recurrence rate was lower (P < 0.05). Conclusion rt-PA intravenous thrombolysis can improve the proportion of good outcomes in the patients with minor ischaemic stroke in 90 days， especially LAA subtype， reduce the recurrence rate， and it has good safety.
[Key words] Minor ischaemic stroke； Recombinant tissue plasminogen activator； Thrombolytic therapy； TOAST etiology
急性缺血性腦卒中(acute ischaemic stroke，AIS)的静脉溶栓可以明显降低患者的残疾率和死亡率，能够明显改善患者的预后。因此，对于AIS，目前国际指南已将应用重组人组织型纤溶酶原激活剂(recombinant tissue plasminogen activator，rt-PA)静脉溶栓治疗作为第一推荐，然而仅有1%～5%的患者接受此治疗，在没有接受静脉溶栓治疗的患者中，轻型缺血性卒中(minor ischemic stroke，MIS)及卒中症状快速恢复是其中一个重要的原因[1]。虽然MIS定义不一，一般是指脑卒中后症状较轻，仅仅表现为轻度神经功能缺损的AIS[2]。目前关于MIS的rt-PA静脉溶栓远期预后结论不一致，有研究认为，接受溶栓的MIS患者可以获得好的预后结果[3-5]，也有研究认为，MIS静脉溶栓治疗并不能远期获益[6-8]。因此，承德市中心医院(以下简称“我院”)开展了轻型卒中rt-PA静脉溶栓治疗，将MIS患者进行TOAST病因分型，明确病因后，再与对照组比较，以观察MIS患者接受rt-PA静脉溶栓治疗的效果，同时评估MIS静脉溶栓的安全性。, 百拇医药(朱海暴 杨静 沈永玲 齐丽敏 冯丽 )