Asadi Bahador, Askari Gholam Reza, Khorvash Fariborz, Bagherpur Ali, Mehrabi Farzad, Karimi Mohammad, Ghasemi Majid, Najjaran Abolfazl
Department of Neurology, Medical University of AJA, Tehran, Iran.
Int J Prev Med. 2013 May;4(Suppl 2):S306-12.
Ischemic brain strokes consisttwo-thirdsof strokesand their complications bear a lot of disability for patient and society. In this study, we seek for effect of Erythropoietin on ischemic brain stroke's outcomes according to National Institutes of Health Stroke Scale (NIHSS) changes.
This study is a RCT (randomized clinical trial). All patients with focal neurologic deficit with primary suspicion of brain stroke undergone neuroimaging evaluations. After confirmation of new ischemic brain stroke, the patients with inclusion criteria'srandomized into two groups of cases and controls. NIHSS was defined for each patient and all patients received a routine treatment protocol. Erythropoietin 16,000 IU as a bolus intravenous dose was given to case patients as soon as neuroimaging study confirmed new ischemic stroke and continued as 8000 IU each 12 h up to total dose of 56,000 IU during 3 days. Patients re-evaluated at days 14 and 28 and NIHSS was assessed by another neurologist blinded to patient's group. Finally, NIHSS changes of both groups compared with each other's.
Evaluations revealed that in days14 and 28 during follow-up, Erythropoietin was effective in NIHSS (P= 0.0001). This effect was of value in level of consciousness Commands (P= 0.024), facial palsy (P= 0.003), motor arm (P= 0.0001), motor leg (P= 0.0001), sensory (P= 0.009), and best language (P= 0.023).
Administration of high-dose erythropoietin in first 24 h can be effective on reduction of ischemic stroke complication. A larger scale clinical trial is warranted.
缺血性脑卒占脑卒中的三分之二，其并发症给患者和社会带来诸多残疾问题。在本研究中，我们根据美国国立卫生研究院卒中量表（NIHSS）的变化来探寻促红细胞生成素对缺血性脑卒结局的影响。
本研究为一项随机对照试验（RCT）。所有初诊怀疑为脑卒中且有局灶性神经功能缺损的患者均接受了神经影像学评估。在确诊为新发缺血性脑卒后，符合纳入标准的患者被随机分为病例组和对照组。为每位患者确定NIHSS评分，所有患者均接受常规治疗方案。一旦神经影像学研究证实新发缺血性脑卒中，即给病例组患者静脉推注16000 IU促红细胞生成素，随后每12小时给予8000 IU，持续3天，总剂量达56000 IU。在第14天和第28天对患者进行重新评估，由另一位对患者分组情况不知情的神经科医生评估NIHSS评分。最后，比较两组的NIHSS评分变化。
评估显示，在随访的第14天和第28天，促红细胞生成素对NIHSS评分有显著效果（P = 0.0001）。这种效果在意识指令水平（P = 0.024）、面瘫（P = 0.003）、上肢运动（P = 0.0001）、下肢运动（P = 0.0001）、感觉（P = 0.009）和最佳语言能力（P = 0.023）方面均有体现。
在发病后24小时内给予大剂量促红细胞生成素可有效减少缺血性脑卒中并发症。有必要开展更大规模的临床试验。
