Renal Division, Baystate Medical Center, Springfield MA, USA.
Nephrol Dial Transplant. 2010 Apr;25(4):1150-7. doi: 10.1093/ndt/gfp619. Epub 2009 Nov 27.
Thrombolytic therapy is an effective treatment modality for acute ischaemic stroke within 3 hours of symptom onset. Its safety and efficacy have not been studied in patients with chronic kidney disease (CKD), who are known to have abnormalities in coagulation and platelet function.
We studied all patients who consecutively received intravenous thrombolytic therapy for acute stroke at our hospital from 2005-2009 (n = 74). Alteplase was administered to patients deemed eligible by National Institute of Health criteria per protocol. We studied associations between admission renal dysfunction [estimated glomerular filtration rate (eGFR) <60ml/min/1.73 m(2)] and in-hospital outcomes: intracranial haemorrhage (ICH), poor functional status (modified Rankin score 3-6) and death.
Mean +/- SD age was 66.4 +/- 16.9 years with 39 (52.7%) men and 46 (62.2%) Caucasian. Twenty patients (27.0%) had eGFR <60 and were older, with a higher prevalence of diabetes and coronary artery disease than patients with eGFR > or =60. Presenting stroke severity, blood pressure and time to alteplase were similar in the two groups. Symptomatic ICH occurred in two patients with eGFR > or =60. Asymptomatic and symptomatic ICH considered together showed no difference in these event rates (20% in eGFR <60 vs 11.1% in eGFR > or =60, P = 0.321). There was no difference in poor functional status (70.0% in eGFR <60 vs 57.4% in eGFR > or =60, P = 0.324) or in-hospital death outcomes (10.0% in eGFR <60 vs 7.4% in eGFR > or =60, P = 0.717). Multivariate logistic regression analysis revealed no association between eGFR <60 and in-hospital outcomes, while increasing age was associated with poor functional status [odds ratio 1.03 (1.00-1.06, P = 0.047)].
In our limited sample size study, presence of eGFR <60 in patients receiving thrombolytic therapy for acute stroke was not found to be associated with increased ICH, poor functional outcome or death. These findings suggest that use of thrombolytics in acute stroke is appropriate in patients with renal dysfunction.
溶栓疗法是治疗发病 3 小时内的急性缺血性脑卒中的有效手段。患有慢性肾脏病（CKD）的患者凝血和血小板功能异常，溶栓疗法的安全性和有效性尚未得到研究。
我们研究了 2005 年至 2009 年期间在我院连续接受急性脑卒中静脉溶栓治疗的所有患者（n = 74）。根据国家卫生研究院的标准，符合条件的患者给予阿替普酶治疗。我们研究了入院时肾功能障碍（估算肾小球滤过率[eGFR]＜60ml/min/1.73 m2）与院内结局之间的关系：颅内出血（ICH）、功能状态不良（改良 Rankin 评分 3-6 分）和死亡。
患者平均年龄为 66.4±16.9 岁，39 例（52.7%）为男性，46 例（62.2%）为白人。20 例（27.0%）患者 eGFR＜60，年龄较大，糖尿病和冠状动脉疾病的患病率高于 eGFR≥60 的患者。两组患者的发病严重程度、血压和阿替普酶治疗时间相似。两组无症状和有症状 ICH 的发生率相似（eGFR＜60 的患者为 20%，eGFR≥60 的患者为 11.1%，P=0.321）。功能状态不良（eGFR＜60 的患者为 70.0%，eGFR≥60 的患者为 57.4%，P=0.324）或院内死亡结局（eGFR＜60 的患者为 10.0%，eGFR≥60 的患者为 7.4%，P=0.717）也无差异。多变量逻辑回归分析显示，eGFR＜60 与院内结局之间无关联，而年龄增长与功能状态不良相关[比值比 1.03（1.00-1.06，P=0.047）]。
在我们的有限样本量研究中，接受急性脑卒中溶栓治疗的患者中 eGFR＜60 与 ICH 增加、功能状态不良或死亡无关。这些发现表明，在肾功能障碍患者中使用溶栓药物治疗急性脑卒中是合适的。
