Department of Internal Medicine, Faculty of Medicine, Thammasat University, Thailand.
Neurol India. 2011 May-Jun;59(3):351-4. doi: 10.4103/0028-3886.82723.
Patients with acute ischemic stroke who had early neurological improvement had better functional outcome. The purpose of this study was to determine factors associated with early clinical improvement and early worsening in patients with acute ischemic stroke treated with intravenous thrombolysis.
Patients treated with intravenous recombinant tissue plasminogen activator (rtPA) between August 2008 and November 2010 were the subjects of this study. Early improvement was defined by marked, clinical improvement or complete recovery at 24 h (National Institutes of Health Stroke Scale (NIHSS) 0-4 at 24 h). Early worsening was defined by an increase in NIHSS ≥1 from baseline. The baseline characteristics were compared between patients with and without outcome of interest.
Of the 203 patients studied, 19 (9.4%) patients had complete recovery and 68 (33.5%) patients had marked clinical improvement (NIHSS 1-4) at 24 h. Most patients with early clinical improvement (86%) had favorable outcome at three months. Of the 22 (10.8%) patients who had early clinical worsening, only three (14%) patients achieved favorable outcome at three months and six (29%) patients died. Multivariate analysis revealed that older age (≥70 years old) (odd ratio (OR) 0.498, P = 0.049), severe stroke (NIHSS ≥15) (OR 0.154, P < 0.0001) and having intracerebral hemorrhage (ICH) (OR 0.364, P = 0.032) were inversely associated with early improvement. History of transient ischemic attack (TIA) (OR 7.724, P = 0.043) and ICH (OR 4.477, P = 0.008) were related to early worsening.
The presence of early clinical improvement or worsening within 24 h after treatment with rtPA had major impact on the outcome at three months.
急性缺血性脑卒中患者在早期神经功能改善后，其功能结局较好。本研究旨在确定接受静脉溶栓治疗的急性缺血性脑卒中患者早期临床改善和早期恶化的相关因素。
本研究的对象为 2008 年 8 月至 2010 年 11 月接受静脉重组组织型纤溶酶原激活剂（rtPA）治疗的患者。早期改善定义为 24 小时时出现显著的临床改善或完全恢复（NIHSS 评分 0-4 分）。早期恶化定义为基线时 NIHSS 增加≥1 分。比较了有和无研究结果的患者之间的基线特征。
在 203 例患者中，19 例（9.4%）患者在 24 小时时完全恢复，68 例（33.5%）患者出现明显的临床改善（NIHSS 评分 1-4 分）。大多数早期临床改善患者（86%）在 3 个月时预后良好。22 例（10.8%）患者早期出现临床恶化，仅 3 例（14%）患者在 3 个月时预后良好，6 例（29%）患者死亡。多变量分析显示，年龄较大（≥70 岁）（比值比（OR）0.498，P=0.049）、严重脑卒中（NIHSS 评分≥15 分）（OR 0.154，P<0.0001）和颅内出血（ICH）（OR 0.364，P=0.032）与早期改善呈负相关。短暂性脑缺血发作（TIA）史（OR 7.724，P=0.043）和 ICH（OR 4.477，P=0.008）与早期恶化相关。
rtPA 治疗后 24 小时内出现的早期临床改善或恶化对 3 个月时的结局有重大影响。
