Department of Neurology, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC.
Eur Neurol. 2013;70(5-6):316-21. doi: 10.1159/000353296. Epub 2013 Sep 27.
One complication of thrombolysis is intracranial hemorrhage (ICH). We investigated whether treatment with tissue plasminogen activator (t-PA) for ischemic infarction results in a higher risk of ICH in patients with kidney dysfunction, who are predisposed to treatment complications due to their bleeding tendency.
A total of 297 patients given thrombolytic therapy for ischemic stroke were classified into 2 groups on the basis of their estimated renal glomerular filtration rate (eGFR). The outcome measures included the incidence of ICH and modified Rankin scale scores at 1 month and 1 year.
ICH was more common in the renal dysfunction group (23 vs. 12.5%). Nevertheless, multivariate logistic regression showed that the odds of ICH were not high in the group with low eGFR. Also, eGFR values <60 ml/min/1.73 m(2) did not predict the odds for functional dependence or death at 1 month and 1 year.
After adjusting for confounding factors, the odds ratio for ICH was not higher in intravenous t-PA-treated stroke patients with renal dysfunction. A trend to the occurrence of ICH among these patients, however, was noted. Renal dysfunction does not predict the odds for functional dependence or death at 1 month and 1 year.
溶栓治疗的一个并发症是颅内出血（ICH）。我们研究了肾功能障碍患者使用组织型纤溶酶原激活物（t-PA）治疗缺血性梗死是否会增加 ICH 的风险，这些患者由于出血倾向而易发生治疗并发症。
根据估计肾小球滤过率（eGFR），将 297 名接受溶栓治疗的缺血性脑卒中患者分为 2 组。主要转归包括ICH 的发生率以及 1 个月和 1 年的改良 Rankin 量表评分。
肾功能障碍组 ICH 更常见（23%比 12.5%）。然而，多变量逻辑回归显示 eGFR 较低组发生 ICH 的几率并不高。此外，eGFR 值<60ml/min/1.73m(2)不能预测 1 个月和 1 年内的功能依赖性或死亡率。
调整混杂因素后，肾功能障碍的静脉内 t-PA 治疗的脑卒中患者发生 ICH 的比值比并不高。然而，这些患者ICH 发生率呈上升趋势。肾功能障碍不能预测 1 个月和 1 年内的功能依赖性或死亡率。
