基于磁敏感加权成像的溶栓后出血患者抗血小板治疗的临床价值：一项前瞻性初步研究。

The clinical value of antiplatelet therapy for patients with hemorrhage after thrombolysis based on susceptibility-weighted imaging: a prospective pilot study.

机构信息

Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated People's Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai 200233, China.

出版信息

Eur J Radiol. 2012 Dec;81(12):4094-8. doi: 10.1016/j.ejrad.2012.08.002. Epub 2012 Aug 24.

DOI:10.1016/j.ejrad.2012.08.002

PMID:22921680

Abstract

PURPOSE

To evaluate treatment decision-making based on susceptibility-weighted imaging (SWI) in patients with hemorrhage after thrombolysis.

MATERIALS AND METHODS

One hundred and forty-six patients without intracranial hemorrhage on CT after receiving recombinant tissue plasminogen activator (rt-PA) were allocated to two groups: antiplatelets (n=72), who received antiplatelet therapy 24h after rt-PA for 10 days; and non-antiplatelets (n=74), who received no antiplatelet therapy. Twenty-two patients with SWI-detected microbleeds (MBs) or hemorrhagic transformation (HT) in the antiplatelets group (Group A) and 28 with MB or HT in the non-antiplatelets group (Group B) were included in this study.

RESULTS

Sixteen patients had MB and six HT in Group A; 18 had MB, six HT, and four parenchymal hemorrhage (PH) in Group B. National Institutes of Health Stroke Scale (NIHSS) scores at 7 and 14 days and the Modified Rankin Scale (mRS) at 90 days post-rt-PA were significantly lower in Group B than in Group A, duration of hospitalization was significantly shorter, and the favorable outcome rate was higher at 90 days (P<0.05). There were no other significant differences. SWI evaluation at 14 days revealed eight patients with MB, 11 HT, and three PH in Group A; in Group B, 16 had MB, five HT, and one PH, with resolution of hemorrhage in six patients.

CONCLUSIONS

Treatment decision-making based on SWI in acute stroke after thrombolysis was validated by the significantly reduced NIHSS score after 7/14 days, improved outcome, and reduced mRS in hemorrhage patients without antiplatelet therapy.

摘要

目的

评估溶栓后出血患者基于磁敏感加权成像（SWI）的治疗决策。

材料和方法

146 例接受重组组织型纤溶酶原激活剂（rt-PA）治疗后 CT 未见颅内出血的患者分为两组：抗血小板组（n=72），rt-PA 后 24 小时给予抗血小板治疗 10 天；非抗血小板组（n=74），未给予抗血小板治疗。抗血小板组（A 组）22 例 SWI 显示微出血（MB）或出血性转化（HT），非抗血小板组（B 组）28 例显示 MB 或 HT。

结果

A 组 16 例 MB 伴 6 例 HT，18 例 MB 伴 6 例 HT 伴 4 例脑实质出血（PH）；B 组 18 例 MB，6 例 HT，4 例 PH。A 组 NIHSS 评分在第 7 天和第 14 天、第 90 天 mRS 评分显著低于 B 组，住院时间显著缩短，第 90 天时预后良好率更高（P<0.05）。其他无显著差异。SWI 在第 14 天评估时，A 组 8 例 MB 伴 11 例 HT 伴 3 例 PH，B 组 16 例 MB 伴 5 例 HT 伴 1 例 PH，6 例出血吸收。