不仅血糖、早期梗死征象、大脑中动脉高密度征、年龄、神经功能缺损评分，而且心房颤动也是静脉注射重组组织型纤溶酶原激活剂后症状性颅内出血的预测因素。
Not only the Sugar, Early infarct sign, hyperDense middle cerebral artery, Age, Neurologic deficit score but also atrial fibrillation is predictive for symptomatic intracranial hemorrhage after intravenous recombinant tissue plasminogen activator.
作者信息
Muengtaweepongsa Sombat, Prapa-Anantachai Pornpoj, Dharmasaroja Pornpat A
机构信息
Department of Medicine, Division of Neurology, Stroke Excellence Center, Thammasat University, Pathum Thani, Thailand.
出版信息
J Neurosci Rural Pract. 2017 Jan-Mar;8(1):49-54. doi: 10.4103/0976-3147.193548.
BACKGROUND
Symptomatic intracranial hemorrhage (sICH) is the most unwanted adverse event in patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (i.v. rt-PA). Many tool scores are available to predict the probability of sICH. Among those scores, the Sugar, Early infarct sign, hyperDense middle cerebral artery, Age, Neurologic deficit (SEDAN) gives the highest area under the curve-receiver operating characteristic value.
OBJECTIVE
We aimed to examine any factors other than the SEDAN score to predict the probability of sICH.
METHODS
Patients with acute ischemic stroke treated with i.v. rt-PA within 4.5 h time window from January 2010 to July 2012 were evaluated. Compiling demographic data, risk factors, and comorbidity (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation (AF), ischemic heart disease, valvular heart disease, previous stroke, gout, smoking cigarette, drinking alcoholic beverage, family history of stroke, and family history of ischemic heart disease), computed tomography scan of patients prior to treatment with rt-PA, and assessing the National Institutes of Health Stroke Scale (NIHSS) score for the purpose of calculating SEDAN score were analyzed.
RESULTS
Of 314 patients treated with i.v. rt-PA, there were 46 ICH cases (14.6%) with 14 sICH (4.4%) and 32 asymptomatic intracranial hemorrhage cases (10.2%). The rate of sICH occurrence was increased in accordance with the increase in the SEDAN score and AF. Age over 75 years, early infarction, hyperdense cerebral artery, baseline blood sugar more than 12 mmol/l, NIHSS as 10 or more, and AF were the risk factors to develop sICH after treated with rt-PA at 1.535, 2.501, 1.093, 1.276, 1.253, and 2.492 times, respectively.
CONCLUSIONS
Rather than the SEDAN score, AF should be a predictor of sICH in patients with acute ischemic stroke after i.v. rt-PA treatment in Thai population.
背景
症状性颅内出血（sICH）是接受静脉注射重组组织型纤溶酶原激活剂（i.v. rt-PA）的急性缺血性脑卒中患者最不良的不良事件。有许多工具评分可用于预测sICH的概率。在这些评分中，Sugar、早期梗死征象、大脑中动脉高密度、年龄、神经功能缺损（SEDAN）评分的曲线下面积-受试者操作特征值最高。
目的
我们旨在研究除SEDAN评分外的任何因素对sICH概率的预测情况。
方法
对2010年1月至2012年7月在4.5小时时间窗内接受i.v. rt-PA治疗的急性缺血性脑卒中患者进行评估。收集人口统计学数据、危险因素和合并症（高血压、糖尿病、血脂异常、心房颤动（AF）、缺血性心脏病、心脏瓣膜病、既往卒中、痛风、吸烟、饮酒、卒中家族史和缺血性心脏病家族史），rt-PA治疗前患者的计算机断层扫描，并评估美国国立卫生研究院卒中量表（NIHSS）评分以计算SEDAN评分。
结果
在314例接受i.v. rt-PA治疗的患者中，有46例ICH病例（14.6%），其中14例sICH（4.4%）和32例无症状颅内出血病例（10.2%）。sICH的发生率随着SEDAN评分和AF的增加而增加。75岁以上、早期梗死、大脑动脉高密度、基线血糖超过12 mmol/l、NIHSS为10分或更高以及AF是rt-PA治疗后发生sICH的危险因素，其发生风险分别为1.535、2.501、1.093、1.276、1.253和2.492倍。
结论
在泰国人群中，对于接受i.v. rt-PA治疗的急性缺血性脑卒中患者，AF而非SEDAN评分应是sICH的预测指标。
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