【摘要】：目的 探討心源性卒中患者重組組織型纖溶酶原激活劑(rt-PA)靜脈溶栓后血管再通、缺血組織再灌注及3個(gè)月預(yù)后的神經(jīng)功能結(jié)局的影響。 方法 回顧性分析浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院神經(jīng)內(nèi)科2009年6月至2014年1月期間接受rt-PA靜脈溶栓治療,并在溶栓前后均接受多模式頭顱磁共振(MRP)掃描的缺血性卒中患者臨床及影像學(xué)資料。根據(jù)動(dòng)脈閉塞評(píng)分(Arterial occlusive lesion scale, AOL)評(píng)價(jià)溶栓后血管再通情況。以腦血流達(dá)峰時(shí)間(Time to peak, Tmax)6s區(qū)域?yàn)榻M織低灌注區(qū),將溶栓后24h這一區(qū)域縮減60%定義為溶栓后再灌注。按中國缺血性卒中亞型分類(Chinese ischemic stroke subclassification, CISS)分型將入組患者分為心源性卒中與非心源性卒中組,比較兩組患者的臨床特點(diǎn)和溶栓后血管再通、組織再灌注及3個(gè)月臨床預(yù)后的差異。 結(jié)果 共76例患者納入分析,心源性卒中40例(52.6%),其中房顫者37例(92.5%)。心源性卒中與非心源性卒中組相比,既往吸煙史者較少(17.5%vs.50%,χ2=9.066,P=0.003),同型半胱氨酸水平較低(13.4±5.9vs.19.0±11.9umol/L, t=2.613,P=0.016),但兩組間溶栓后血管再通率、再灌注率及3月床預(yù)后無統(tǒng)計(jì)學(xué)差異。心源性卒中與非心源性卒中兩組出血轉(zhuǎn)化無明顯差異(34.6%vs.38.7%, x2=0.102,P=0.750)。影響血管再通的獨(dú)立因素為：大動(dòng)脈粥樣硬化性卒中(OR=0.292,95%CI=0.088～0.966, P=0.044);溶栓后組織再灌注的獨(dú)立影響因素為女性(OR=0.081,95%CI=0.013～0.514, P=0.008)和血管再通(OR=29.39,95%CI=4.534～190.521, P=0.000)。影響缺血性卒中3個(gè)月預(yù)后的獨(dú)立因素為女性(OR=0.138,95%CI=0.020～0.944, P=0.044),基線NIHSS (OR=0.610,95%CI=0.459～0.812, P=0.001)及血管再通(OR=47.567,95%CI=3.904～579.546, P=0.002).影響心源性卒中3月后預(yù)后因素為基線NIHSS (OR=0.7198,95%CI=0.569～0.909, P=0.006)。 結(jié)論 心源性卒中并不影響靜脈溶栓后血管再通和組織再灌注。心源性卒中患者的3月臨床結(jié)局不劣于非心源性卒中。
[Abstract]:Objective to investigate the effects of intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) on vascular recanalization, ischemic tissue reperfusion and 3-month prognosis in patients with cardiogenic apoplexy. Methods from June 2009 to January 2014, the Department of Neurology of the second affiliated Hospital of Zhejiang University Medical College was treated with rt-PA intravenous thrombolytic therapy. The clinical and imaging data of ischemic stroke patients underwent multi-mode magnetic resonance imaging (MRP) before and after thrombolysis. The recanalization of blood vessels after thrombolysis was evaluated according to the arterial occlusion score (Arterial occlusive lesion scale, AOL). The peak time of cerebral blood flow (Time to peak, Tmax) 6s) was taken as tissue low perfusion area, and the area reduced by 60% at 24h after thrombolysis was defined as reperfusion after thrombolysis. The patients were divided into cardiac stroke group and non-cardiogenic stroke group according to the (Chinese ischemic stroke subclassification, CISS) classification of Chinese ischemic stroke subtype. The clinical characteristics and vascular recanalization after thrombolysis were compared between the two groups. The difference of clinical prognosis between tissue reperfusion and 3 months. Results among 76 patients, 40 (52.6%) were cardiogenic apoplexy, and 37 (92.5%) were atrial fibrillation. Compared with the non-cardiogenic stroke group, the previous smoking history was lower (17.5% vs. 50%, 蠂 2 = 9.06 6, P < 0.003), and homocysteine level was lower (13.4 鹵5.9vs.19.0 鹵11.9umol / L, t = 2.613, P = 0.016), compared with the non-cardiogenic stroke group (17.5% vs. 50%, 蠂 2 = 9.06 6, P = 0.003). However, there was no significant difference in vascular recanalization rate, reperfusion rate and 3-month bed prognosis between the two groups. There was no significant difference between cardiac stroke group and non-cardiogenic stroke group (34.6% vs. 38.7%, x2 / 0.102, P = 0.750). The independent factors influencing vascular recanalization were as follows: great atherosclerotic stroke (OR=0.292,95%CI=0.088~0.966, P0. 044); The independent influencing factors of tissue reperfusion after thrombolysis were female (OR=0.081,95%CI=0.013~0.514, P0. 008) and vascular recanalization (OR=29.39,95%CI=4.534~190.521, P0. 000). The independent factors influencing the 3-month prognosis of ischemic stroke were female (OR=0.138,95%CI=0.020~0.944, P0. 044), baseline NIHSS (OR=0.610,95%CI=0.459~0.812, P0. 001) and recanalization (OR=47.567,95%CI=3.904~579.546,). (P = 0.002). Baseline NIHSS (OR=0.7198,95%CI=0.569~0.909, P = 0.006) was the prognostic factor after 3 months of cardiogenic stroke. Conclusion Cardiogenic stroke does not affect vascular recanalization and tissue reperfusion after intravenous thrombolysis. The 3-month clinical outcome of patients with cardiogenic stroke was no worse than that of non-cardiogenic stroke.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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