急性心源性栓塞性卒中动脉内尿激酶溶栓的病例对照分析。

A case-control analysis of intra-arterial urokinase thrombolysis in acute cardioembolic stroke.

作者信息

Inoue Takeshi, Kimura Kazumi, Minematsu Kazuo, Yamaguchi Takenori

机构信息

Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita-City, Osaka, Japan.

出版信息

Cerebrovasc Dis. 2005;19(4):225-8. doi: 10.1159/000083887. Epub 2005 Feb 8.

DOI:10.1159/000083887

PMID:15703466

Abstract

BACKGROUND

Intra-arterial urokinase (IA-UK) thrombolysis is frequently given in Japan to selected patients with acute cerebral artery occlusion. However, it is not clear whether or not IA-UK thrombolysis has an efficacy for acute stroke patients. The purpose of this study was to assess the effects of IA-UK thrombolysis in acute cardioembolic stroke patients, by performing a case-control analysis using data from Japan's Multicenter Stroke Investigator's Collaboration (J-MUSIC).

METHODS

16,922 acute ischemic stroke patients were enrolled into J-MUSIC. From these patients, we selected 91 patients (UK group) who met the following criteria: treatment with IA-UK; 20-75 years of age; cardioembolic stroke; presenting with a carotid stroke; admission within 4.5 h of symptom onset, and a National Institutes of Health Stroke Scale (NIHSS) score of 5-22 points on admission. A control group of 182 patients without IA-UK treatment and matched to the NIHSS score, gender, and age was chosen. We compared the modified Rankin scale (mRS) score at discharge and the mortality between the 2 groups.

RESULTS

In both groups, the mean age was 65 +/- 8 years, and the median NIHSS score was 14. The mean interval between symptom onset and UK administration was 3.4 +/- 1.3 h, and the IA-UK dose was 392,000 +/- 200,000 units. The mRS score at discharge was lower in the UK group than in the control group (mean, SD, median; 2.8, 2.9, 2 in UK group vs. 3.3, 1.8, 4, in the control, respectively p = 0.031). A favorable outcome (mRS of 0-2) was more frequently observed in the UK group (50.5%) than in the control group (34.1%, p = 0.0124). No difference in the mortality rate was seen between the UK group (11.0%) and the control group (13.3%). As well, there was no difference in the length of hospital stay between the UK group (46 +/- 41 days, mean +/- SD) and the control group (42 +/- 42 days, mean +/- SD).

CONCLUSIONS

IA-UK thrombolytic therapy may improve the outcome in hyperacute cardioembolic stroke patients.

摘要

背景

在日本，动脉内尿激酶（IA-UK）溶栓常用于部分急性脑动脉闭塞患者。然而，IA-UK溶栓对急性脑卒中患者是否有效尚不清楚。本研究旨在通过使用日本多中心卒中研究者协作组（J-MUSIC）的数据进行病例对照分析，评估IA-UK溶栓对急性心源性栓塞性卒中患者的影响。

方法

16922例急性缺血性卒中患者纳入J-MUSIC研究。从这些患者中，我们选取了91例患者（尿激酶组），他们符合以下标准：接受IA-UK治疗；年龄在20 - 75岁之间；心源性栓塞性卒中；表现为颈动脉卒中；症状发作后4.5小时内入院，且入院时美国国立卫生研究院卒中量表（NIHSS）评分为5 - 22分。选择182例未接受IA-UK治疗且在NIHSS评分、性别和年龄方面匹配的患者作为对照组。我们比较了两组出院时的改良Rankin量表（mRS）评分和死亡率。

结果

两组患者的平均年龄均为65±8岁，NIHSS评分中位数为14分。症状发作至尿激酶给药的平均间隔时间为3.4±1.3小时，IA-UK剂量为392000±200000单位。尿激酶组出院时的mRS评分低于对照组（尿激酶组均值、标准差、中位数分别为2.8、2.9、2；对照组分别为3.3、1.8、4，p = 0.031）。尿激酶组（50.5%）比对照组（34.1%，p = 0.0124）更常观察到良好结局（mRS为0 - 2）。尿激酶组（11.0%）和对照组（13.3%）的死亡率无差异。同样，尿激酶组（46±41天，均值±标准差）和对照组（42±42天，均值±标准差）的住院时间也无差异。