Arenillas J F, Ispierto L, Millán M, Escudero D, Pérez de la Ossa N, Dorado L, Guerrero C, Serena J, Castillo J, Dávalos A
Department of Neurosciences, Stroke Unit, Germans Trias i Pujol Universitary Hospital, Universitat Autònoma de Barcelona, Carretera del Canyet, 08916 Badalona, Barcelona, Spain.
Neurology. 2008 Jul 15;71(3):190-5. doi: 10.1212/01.wnl.0000317092.21210.e6.
The metabolic syndrome (MetS) is a cluster of vascular risk factors associated with a prothrombotic state. We aimed to evaluate the impact of MetS on the response to systemic tPA treatment in patients with acute middle cerebral artery (MCA) ischemic stroke.
We studied 100 consecutive patients with ischemic stroke with MCA occlusions on prebolus transcranial Doppler (TCD) examination treated with tPA following SITS-MOST criteria. MetS was diagnosed following AHA/NHLBI-2005 criteria. Resistance to thrombolysis was defined as the absence of TCD-assessed complete MCA recanalization 24 hours after tPA infusion. Infarct volume was measured on CT scans. Long-term clinical outcome was evaluated by the modified Rankin scale (mRS) score at day 90.
Fifty-eight (58%) patients fulfilled MetS criteria. Median prebolus NIH Stroke Scale score was 17. Forty (42%) patients showed resistance to clot dissolution, and 53 (53%) had poor clinical outcomes (mRS > 2). A multivariable-adjusted logistic regression model identified MetS as independently associated with resistance to thrombolysis (OR 4.7, 95% CI [1.7-13.6], p = 0.004). In the whole sample, MetS was associated with mRS > 2 (OR 2.4 [1.1-5.4], p = 0.03), although this association was no longer significant after multivariable adjustment. However, in patients with atherothrombotic stroke, MetS emerged as an independent predictor of poor long-term outcome (adjusted OR 13.9 [1.3-148.7], p = 0.02).
In our series, the metabolic syndrome was associated with a poor response to thrombolysis in patients with acute middle cerebral artery occlusions, as reflected by a higher resistance to clot dissolution.
代谢综合征（MetS）是一组与血栓前状态相关的血管危险因素。我们旨在评估MetS对急性大脑中动脉（MCA）缺血性卒中患者全身组织型纤溶酶原激活剂（tPA）治疗反应的影响。
我们研究了100例在推注前经颅多普勒（TCD）检查显示MCA闭塞的缺血性卒中患者，这些患者按照SITS-MOST标准接受tPA治疗。根据美国心脏协会/美国国立心肺血液研究所2005年标准诊断MetS。溶栓抵抗定义为tPA输注后24小时经TCD评估未实现MCA完全再通。通过CT扫描测量梗死体积。在第90天用改良Rankin量表（mRS）评分评估长期临床结局。
58例（58%）患者符合MetS标准。推注前美国国立卫生研究院卒中量表评分中位数为17分。40例（42%）患者显示对血栓溶解有抵抗，53例（53%）患者临床结局不佳（mRS>2）。多变量调整逻辑回归模型确定MetS与溶栓抵抗独立相关（比值比4.7，95%可信区间[1.7 - 13.6]，p = 0.004）。在整个样本中，MetS与mRS>2相关（比值比2.4[1.1 - 5.4]，p = 0.03），尽管在多变量调整后这种关联不再显著。然而，在动脉粥样硬化血栓形成性卒中患者中，MetS成为长期不良结局的独立预测因素（调整后比值比13.9[1.3 - 148.7]，p = 0.02）。
在我们的系列研究中，代谢综合征与急性大脑中动脉闭塞患者对溶栓治疗的反应不佳相关，表现为对血栓溶解的抵抗性更高。
