Department of Medicine and Therapeutics, Western Infirmary and Faculty of Medicine, University of Glasgow, 44 Church Street, Glasgow G11 6NT, Scotland.
Stroke. 2011 Sep;42(9):2618-21. doi: 10.1161/STROKEAHA.110.611210. Epub 2011 Jul 14.
Hypothermia is neuroprotective in ischemic stroke models. The influence of baseline body temperature on outcomes after thrombolytic therapy is unclear. We examined outcomes after alteplase treatment across baseline body temperature for patients with ischemic stroke in data held within the Virtual International Stroke Trials Archive (VISTA; 1998 to 2007).
We collated data on age, baseline severity (National Institutes of Health Stroke Scale), and 90-day modified Rankin Scale score on patients presenting with acute ischemic stroke. We compared 90-day modified Rankin Scale score between thrombolyzed and nonthrombolyzed comparators across baseline body temperature. We report age and baseline National Institutes of Health Stroke Scale-adjusted Cochran-Mantel-Haenszel probability value and proportional OR with 95% CI for improved modified Rankin Scale distribution. We report temperature profiles over 72 hours after stroke by treatment group.
Rankin data were available for 5586 patients with acute ischemic stroke in VISTA (1980 received alteplase). Age and baseline severity were similar (age 68.0±13.0 years versus 69.9±12.3 years, National Institutes of Health Stroke Scale 14.2±5.2 versus 13.0±5.6). Alteplase was associated with improved outcome (OR, 1.49; 95% CI, 1.35 to 1.65, P<0.0001). Alteplase treatment effect was not associated with baseline temperature (P=0.14). Point estimates showed benefit of alteplase treatment across 35.5°C to 37.5°C but showed a negative trend >37.5°C. Alteplase did not influence temperature profiles over 72 hours after stroke.
There is no evidence of influence of body temperature on alteplase treatment response. These results are reassuring that low temperatures across a physiological range do not compromise therapeutic effect of alteplase.
在缺血性卒中模型中，低温具有神经保护作用。基线体温对溶栓治疗后结局的影响尚不清楚。我们在虚拟国际卒中试验档案（VISTA；1998 年至 2007 年）中检查了急性缺血性卒中患者的基线体温范围内接受阿替普酶治疗后的结局。
我们收集了年龄、基线严重程度（国立卫生研究院卒中量表[NIHSS]）和 90 天改良 Rankin 量表评分的数据，这些数据来自急性缺血性卒中患者。我们比较了溶栓和未溶栓患者之间的 90 天改良 Rankin 量表评分。我们报告年龄和基线 NIHSS 调整后的 Cochran-Mantel-Haenszel 概率值和 95%CI 下改良 Rankin 量表分布的优势比，以及改善的结果。我们按治疗组报告了卒中后 72 小时内的体温变化情况。
VISTA 中有 5586 例急性缺血性卒中患者的 Rankin 数据可用（1980 例接受阿替普酶治疗）。年龄和基线严重程度相似（年龄 68.0±13.0 岁与 69.9±12.3 岁，NIHSS 14.2±5.2 与 13.0±5.6）。阿替普酶治疗与改善结局相关（OR，1.49；95%CI，1.35 至 1.65，P<0.0001）。阿替普酶治疗效果与基线体温无关（P=0.14）。点估计显示在 35.5°C 至 37.5°C 之间，阿替普酶治疗有获益，但>37.5°C 呈负趋势。阿替普酶治疗后 72 小时内的体温变化不受影响。
没有证据表明体温对阿替普酶治疗反应有影响。这些结果令人放心，表明在生理范围内的低温不会降低阿替普酶的治疗效果。
