急性缺血性卒中患者治疗前血压与组织型纤溶酶原激活剂诱导的动脉再通的相关性
Association of pretreatment blood pressure with tissue plasminogen activator-induced arterial recanalization in acute ischemic stroke.
作者信息
Tsivgoulis Georgios, Saqqur Maher, Sharma Vijay K, Lao Annabelle Y, Hill Michael D, Alexandrov Andrei V
机构信息
Neurosonology and Stroke Research Program, Barrow Neurological Institute, Phoenix, Arizona, USA.
出版信息
Stroke. 2007 Mar;38(3):961-6. doi: 10.1161/01.STR.0000257314.74853.2b. Epub 2007 Jan 25.
BACKGROUND AND PURPOSE
Elevated systolic blood pressure (SBP) and lack of early vessel recanalization are predictors of poor outcome among patients with stroke treated with systemic tissue plasminogen activator (tPA). We aimed to evaluate the potential relationship between pretreatment SBP and tPA-induced recanalization.
METHODS
Consecutive patients with acute ischemic stroke resulting from intracranial artery occlusion were treated with standard intravenous tPA and assessed with 2-MHz transcranial Doppler for arterial recanalization. Early arterial recanalization was determined with previously validated Thrombolysis in Brain Ischemia flow grading system at 120 minutes after tPA bolus. Functional outcome at 3 months was evaluated using the modified Rankin Scale.
RESULTS
A total of 351 patients received intravenous tPA (mean age: 68.7+/-13.4 years, median National Institutes of Health Stroke Scale score 16.5). Patients with complete recanalization (n=94) had lower mean pretreatment SBP values (152+/-23 mm Hg) than patients with incomplete or absent recanalization (n=257, 160+/-22 mm Hg, P=0.010). Pretreatment SBP levels were inversely associated with complete recanalization (OR per 10-mm Hg increase: 0.85; 95% CI: 0.74 to 0.98, P=0.022) after adjustment for demographics, risk factors, stroke severity, pretreatment Thrombolysis in Brain Ischemia grades, and continuous versus intermittent exposure to transcranial Doppler. Although patients with poor functional 3-month outcomes (modified Rankin Scale >2) had higher pretreatment SBP values (160+/-25 mm Hg) than functionally independent patients (154+/-20 mm Hg, P=0.027), pretreatment SBP levels were not independently associated with functional outcome on multivariable analysis. Age, complete recanalization, baseline National Institutes of Health Stroke Scale score, and time from symptom onset to tPA bolus were independent (P<0.05) predictors of 3-month outcome.
CONCLUSIONS
Higher pretreatment SBP levels are associated with poor recanalization in patients with acute stroke treated with intravenous tPA.
背景与目的
对于接受静脉注射组织型纤溶酶原激活剂（tPA）治疗的卒中患者，收缩压（SBP）升高和早期血管未再通是预后不良的预测因素。我们旨在评估治疗前SBP与tPA诱导的再通之间的潜在关系。
方法
对因颅内动脉闭塞导致急性缺血性卒中的连续患者进行标准静脉注射tPA治疗，并用2兆赫经颅多普勒评估动脉再通情况。在推注tPA后120分钟，使用先前验证的脑缺血溶栓血流分级系统确定早期动脉再通情况。使用改良Rankin量表评估3个月时的功能结局。
结果
共有351例患者接受了静脉注射tPA（平均年龄：68.7±13.4岁，美国国立卫生研究院卒中量表中位数评分16.5）。完全再通的患者（n = 94）治疗前SBP的平均水平（152±23毫米汞柱）低于再通不完全或未再通的患者（n = 257，160±22毫米汞柱，P = 0.010）。在对人口统计学、危险因素、卒中严重程度、治疗前脑缺血溶栓分级以及经颅多普勒的持续或间歇性检查进行校正后，治疗前SBP水平与完全再通呈负相关（每升高10毫米汞柱的比值比：0.85；95%置信区间：0.74至0.98，P = 0.022）。尽管3个月功能结局较差（改良Rankin量表>2）的患者治疗前SBP值（160±25毫米汞柱）高于功能独立的患者（154±20毫米汞柱，P = 0.027），但在多变量分析中，治疗前SBP水平与功能结局无独立相关性。年龄、完全再通、基线美国国立卫生研究院卒中量表评分以及从症状发作到推注tPA的时间是3个月结局的独立（P<0.05）预测因素。
结论
对于接受静脉注射tPA治疗的急性卒中患者，较高的治疗前SBP水平与再通不良相关。
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