Department of Neurology, Helsinki University, Central Hospital, Helsinki, Finland.
Stroke. 2011 Jan;42(1):102-6. doi: 10.1161/STROKEAHA.110.597534. Epub 2010 Nov 24.
treating ischemic stroke with thrombolytic therapy is effective and safe, but limited data exist on its efficacy and safety in different etiologic subtypes.
patients with acute ischemic stroke treated with intravenous thrombolysis between 1995 and 2008 at our hospital were classified according to the Trial of ORG 10172 in Acute Stroke Treatment criteria based on diagnostic evaluation. Clinical outcome of the stroke subtypes by 3-month modified Rankin Scale was compared by multivariate logistic regression. A good outcome was defined as modified Rankin Scale ≤ 2. Symptomatic intracranial hemorrhage was defined according to both National Institute of Neurological Disorders and Stroke and European Cooperative Acute Stroke Study criteria.
of the 957 eligible patients, 41% (389) had cardioembolisms, 23% (217) large-artery atherosclerosis, and 11% (101) small-vessel disease (SVD). A good outcome was more common in SVD than in the other subtypes. Patients with SVD were more often male (64% versus 54%), had a lower baseline National Institutes of Health Stroke Scale score, lower mortality rate, and experienced no symptomatic intracranial hemorrhage. Patients with SVD had a prior stroke more often (20% versus 11%), whereas hypertension, diabetes, hypercholesterolemia, and transient ischemic attacks were equally distributed in all subtypes. Patients with SVD had a better outcome even after adjusting for baseline National Institutes of Health Stroke Scale and glucose level, age, and hyperdense artery sign (OR, 1.81; 1.01 to 3.23). In the adjusted multivariate model, other etiologic groups showed no significant correlation to good outcome.
patients with SVD were spared from bleeding complications and had the best outcome even after adjustment for confounding factors.
溶栓治疗缺血性脑卒中安全有效，但不同病因亚型的疗效和安全性数据有限。
根据诊断评估，采用 Trial of ORG 10172 in Acute Stroke Treatment 标准，将 1995 年至 2008 年在我院接受静脉溶栓治疗的急性缺血性脑卒中患者分为不同亚型。采用多变量逻辑回归比较各亚型患者 3 个月时改良 Rankin 量表（mRS）评分的临床转归。良好转归定义为 mRS≤2。根据 National Institute of Neurological Disorders and Stroke 和 European Cooperative Acute Stroke Study 标准，定义症状性颅内出血。
957 例符合条件的患者中，41%（389 例）为心源性栓塞，23%（217 例）为大动脉粥样硬化，11%（101 例）为小血管疾病（SVD）。SVD 患者的预后明显优于其他亚型。SVD 患者多为男性（64%比 54%），基线 NIHSS 评分较低，死亡率较低，未发生症状性颅内出血。SVD 患者既往卒中发生率较高（20%比 11%），高血压、糖尿病、高胆固醇血症和短暂性脑缺血发作在各亚型中分布均衡。即使调整基线 NIHSS 评分和血糖水平、年龄和高密度动脉征后，SVD 患者的预后仍较好（OR 1.81，1.01 至 3.23）。在调整后的多变量模型中，其他病因组与良好预后无显著相关性。
SVD 患者避免了出血并发症，即使在调整混杂因素后，其预后仍最佳。
