亚洲人群急性缺血性卒中静脉溶栓后症状性颅内出血的预后参数

Prognostic Parameters for Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in an Asian Population.

作者信息

Lokeskrawee Thanin, Muengtaweepongsa Sombat, Patumanond Jayanton, Tiamkao Somsak, Thamangraksat Thanoot, Phankhian Phanyarat, Pleumpanupatand Polchai, Sribussara Paworamon, Kitjavijit Teeraparp, Supap Anake, Rattanaphibool Weerawan, Prisiri Jariya

机构信息

Department of Emergency Medicine, Lampang Hospital, Lampang. Thailand.

Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat Univerisity, Pathum Thani 12120. Thailand.

出版信息

Curr Neurovasc Res. 2017;14(2):169-176. doi: 10.2174/1567202614666170327163905.

DOI:10.2174/1567202614666170327163905

PMID:28356002

Abstract

BACKGROUND

Symptomatic intracranial hemorrhage (sICH) is a major complication after intravenous thrombolysis leading to severe disability and death. The incidence was higher in Asian than in western countries. Prognostic factors across ethnicities are presumably different. Studies in Asian populations are limited.

METHOD

Clinical data from January 2008 to September 2016 in one provincial and four regional hospitals in the northern part of Thailand were retrospectively reviewed. Patients were those with acute ischemic stroke, to whom recombinant tissue plasminogen activator (rt-PA) had been prescribed. They were classified into 3 groups; no intracranial hemorrhage (no ICH), asymptomatic intracranial hemorrhage (asICH) and symptomatic intracranial hemorrhage (sICH), based on clinical and brain imaging (computed tomography or CT). Prognostic parameters were investigated using a multi-level, multivariable ordinal logistic model.

RESULTS

After exclusion of ineligible patients, the remaining 1,172 patients were classified into no ICH (n=923, 78.8%), asICH (n=154, 13.1%) and sICH (n=95, 8.1%). Independent prognostic parameters for intracranial hemorrhage were the National Institutes of Health Stroke Scale (NIHSS) >20 (OR, 3.51; 95% CI, 2.18-5.65; p<0.001), NIHSS >10 (OR, 2.02; 95% CI, 1.42-2.87; p<0.001), use of nicardipine during rt-PA (OR, 1.61; 95% CI, 1.09-2.40; p=0.018), systolic blood pressure (SBP) prior to thrombolysis ≥ 140 mmHg (OR, 1.47; 95% CI, 1.06-2.04; p=0.021), and platelet count <250,000 cell/mm3 (OR, 1.45; 95% CI, 1.04-2.01; p=0.029).

CONCLUSION

Patients with these parameters should be closely monitored. Information should be provided to the patients and their relatives.

摘要

背景

症状性颅内出血（sICH）是静脉溶栓后的主要并发症，可导致严重残疾和死亡。其在亚洲的发病率高于西方国家。不同种族的预后因素可能不同。针对亚洲人群的研究有限。

方法

回顾性分析泰国北部一家省级医院和四家地区医院2008年1月至2016年9月的临床资料。患者为接受重组组织型纤溶酶原激活剂（rt-PA）治疗的急性缺血性卒中患者。根据临床和脑部影像学检查（计算机断层扫描或CT），将他们分为3组：无颅内出血（无ICH）、无症状性颅内出血（asICH）和症状性颅内出血（sICH）。使用多级多变量有序逻辑模型研究预后参数。

结果

排除不符合条件的患者后，其余1172例患者分为无ICH组（n = 923，78.8%）、asICH组（n = 154，13.1%）和sICH组（n = 95，8.1%）。颅内出血的独立预后参数为美国国立卫生研究院卒中量表（NIHSS）>20（比值比[OR]，3.51；95%置信区间[CI]，2.18 - 5.65；p<0.001）、NIHSS>10（OR，2.02；95% CI，1.42 - 2.87；p<0.001）、rt-PA治疗期间使用尼卡地平（OR，1.61；95% CI，1.09 - 2.40；p = 0.018）、溶栓前收缩压（SBP）≥140 mmHg（OR，1.47；95% CI，1.06 - 2.04；p = 0.021）以及血小板计数<250,000个/立方毫米（OR，1.45；95% CI，1.04 - 2.01；p = 0.029）。