Department of Neurology, Masaryk University, St Anne's University Hospital, Pekarská 53, 656 91 Brno, Czech Republic.
Stroke. 2010 Mar;41(3):466-70. doi: 10.1161/STROKEAHA.109.567263. Epub 2010 Feb 4.
Early recanalization is the likely mechanism by which intravenous thrombolysis improves stroke outcomes. Limited data exist on the patterns of early recovery of various brain functions.
Data from the Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic t-PA (CLOTBUST) trial was used to determine time-related trends in neurological function recovery, as measured by National Institutes of Health Stroke Scale (NIHSS) components at baseline, 30, 60, 90, 120 minutes, and 24 hours. Repeated-measures ANOVA was used to compare patients with complete recanalization versus no or partial recanalization of the middle cerebral artery (MCA) at 120 minutes from tissue plasminogen activator bolus. The correlation structure of the NIHSS was analyzed with multivariable factor analysis. The ability of individual components to diagnose recanalization was assessed with area under the receiver operating characteristic curves.
Altogether, 113 patients from the CLOTBUST trial had complete follow-up NIHSS scores available. All received 0.9 mg/kg IV tissue plasminogen activator within 3 hours of symptom onset (mean age 69+/-12 years; 58% men; median NIHSS 16; complete MCA recanalization 27%). All NIHSS components attributable to MCA occlusion contributed with varying degrees to the decrease of the total NIHSS score after MCA recanalization. NIHSS components responded in 2 major and mutually independent clusters representing left and right brain functions. The best performing component in diagnosing recanalization was gaze deviation (area under the receiver operating characteristic curve=0.80), but its results were similar to the total NIHSS score (area under the receiver operating characteristic curve=0.75).
All neurological functions, impaired because of MCA occlusion, recovered after recanalization, although not to the same extent. The total NIHSS score is more useful than the individual components in detecting MCA recanalization.
静脉溶栓改善卒中结局的可能机制是早期再通。目前关于各种脑功能早期恢复模式的数据有限。
利用经颅超声联合系统性组织型纤溶酶原激活剂溶栓治疗缺血性卒中（CLOTBUST）试验的数据，通过国立卫生研究院卒中量表（NIHSS）基线、30、60、90、120 分钟和 24 小时的各个组分，确定神经功能恢复的时间相关趋势。采用重复测量方差分析比较 120 分钟时组织型纤溶酶原激活剂推注后大脑中动脉（MCA）完全再通与无再通或部分再通的患者。采用多变量因子分析分析 NIHSS 的相关结构。采用受试者工作特征曲线下面积评估各个组分诊断再通的能力。
CLOTBUST 试验共有 113 例患者完成了 NIHSS 随访评分。所有患者在症状发作后 3 小时内接受了 0.9 mg/kg IV 组织型纤溶酶原激活剂治疗（平均年龄 69+/-12 岁；58%为男性；中位数 NIHSS 为 16；MCA 完全再通率为 27%）。MCA 闭塞引起的所有 NIHSS 组分在 MCA 再通后对 NIHSS 总分的降低均有不同程度的贡献。NIHSS 组分主要分为左、右大脑功能 2 个相互独立的集群。诊断再通效果最好的组分是眼球运动障碍（受试者工作特征曲线下面积=0.80），但与 NIHSS 总分的结果相似（受试者工作特征曲线下面积=0.75）。
MCA 闭塞引起的所有神经功能在再通后均得到恢复，尽管恢复程度不同。NIHSS 总分比单个组分更能检测 MCA 再通。
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