Nedeltchev Krassen, Fischer Urs, Arnold Marcel, Ballinari Pietro, Haefeli Tobias, Kappeler Liliane, Brekenfeld Caspar, Remonda Luca, Schroth Gerhard, Mattle Heinrich P
Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland.
Stroke. 2006 Dec;37(12):3002-7. doi: 10.1161/01.STR.0000249417.24085.80. Epub 2006 Oct 26.
Thrombolysis has been shown to improve the 3-month outcome of patients with ischemic stroke, but knowledge of the long-term effect of thrombolysis is limited.
The present study compares the long-term outcome of stroke patients who were treated with intra-arterial thrombolysis (IAT) using urokinase with the outcome of patients treated with aspirin. The modified Rankin Scale (mRS) was used to assess the outcome; 173 patients treated with IAT and 261 patients treated with aspirin from the Bernese Stroke Data Bank were eligible for the study. A matching algorithm taking into account patient age and stroke severity on admission (as measured by the National Institute of Health Stroke Scale [NIHSS]) was used to assemble an IAT and an aspirin group.
One hundred and forty-four patients treated with IAT and 147 patients treated with aspirin could be matched and included in the comparative analysis. The median NIHSS score was 14 in each group. At 2 years, 56% of the patients treated with IAT and 42% of the patients treated with aspirin achieved functional independence (mRS, 0 to 2; P=0.037). Clinical outcome was excellent (mRS, 0 to 1) in 40% of the IAT and in 24% of the aspirin patients (P=0.008). Mortality was 23% and 24%, respectively.
The present study provides evidence for a sustained effect of IAT when assessed 2 years after the stroke.
溶栓治疗已被证明可改善缺血性中风患者3个月时的预后，但关于溶栓长期效果的了解有限。
本研究比较了接受尿激酶动脉内溶栓（IAT）治疗的中风患者与接受阿司匹林治疗的患者的长期预后。采用改良Rankin量表（mRS）评估预后；来自伯尔尼中风数据库的173例接受IAT治疗的患者和261例接受阿司匹林治疗的患者符合研究条件。使用一种考虑患者年龄和入院时中风严重程度（通过美国国立卫生研究院卒中量表[NIHSS]测量）的匹配算法来组建IAT组和阿司匹林组。
144例接受IAT治疗的患者和147例接受阿司匹林治疗的患者可进行匹配并纳入比较分析。每组的NIHSS中位数为14分。2年时，56%接受IAT治疗的患者和42%接受阿司匹林治疗的患者实现了功能独立（mRS，0至2；P = 0.037）。40%接受IAT治疗的患者和24%接受阿司匹林治疗的患者临床预后良好（mRS，0至1；P = 0.008）。死亡率分别为23%和24%。
本研究为中风后2年评估时IAT的持续效果提供了证据。
