van Oostenbrugge R J, Hupperts R M M, Lodder J
Department of Neurology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
J Neurol Neurosurg Psychiatry. 2006 Mar;77(3):375-7. doi: 10.1136/jnnp.2005.070292.
The aim of this study was to describe the clinical experience in 184 consecutive stroke patients first-ever treated with recombinant tissue plasminogen activator (rt-PA) at a single Dutch centre, with special emphasis on results among the very old. Outcome parameters were the modified Rankin scale (mRs) at 3 months and symptomatic intracranial haemorrhage (SICH). Outcome was related to age. A total of 184 patients were treated of whom 45 were 80 years of age or older (24%). Sixty two (45%) of 139 patients < 80 years of age and 12 (27%) of 45 patients > or = 80 years of age had a favourable outcome defined as an mRs score of 0 or 1 (OR 2.21; 95% CI: 1.06 to 4.46). There was a good outcome (mRs score < or = 2) in 88 (63%) and 16 (36%) patients, respectively (OR 3.13; 95% CI: 1.55 to 6.30). SICH was observed in four of 139 (2.9%) patients < 80 years of age and in five of 45 (11.1%) patients > or = 80 years of age (OR 4.22; 95% CI: 1.08 to 16.46). The results of this study underline the uncertainty regarding the risk/benefit ratio of rt-PA treatment in acute stroke in patients over 80 years of age.
本研究旨在描述在荷兰一家中心首次接受重组组织型纤溶酶原激活剂（rt-PA）治疗的184例连续性卒中患者的临床经验，特别关注高龄患者的治疗结果。观察指标为3个月时的改良Rankin量表（mRs）评分和症状性颅内出血（SICH）。观察结果与年龄相关。总共184例患者接受了治疗，其中45例年龄在80岁及以上（24%）。139例年龄＜80岁的患者中有62例（45%）获得了良好的预后，定义为mRs评分为0或1（比值比[OR]2.21；95%置信区间[CI]：1.06至4.46）。88例（63%）年龄＜80岁的患者和16例（36%）年龄≥80岁的患者获得了良好的预后（mRs评分≤2）（OR 3.13；95%CI：1.55至6.30）。139例年龄＜80岁的患者中有4例（2.9%）发生了SICH，45例年龄≥80岁的患者中有5例（11.1%）发生了SICH（OR 4.22；95%CI：1.08至16.46）。本研究结果强调了80岁以上急性卒中患者rt-PA治疗风险/获益比的不确定性。
