接受静脉溶栓治疗的卒中患者发生轻微非颅内出血与预后不良

Minor Nonintracranial Hemorrhage and Poor Prognosis among Stroke Patients Undergoing Intravenous Thrombolysis.

作者信息

Qin Xiaoming, Zhao Songyao, Yin Liujie, Dou Hailing, Chen Jie, Wang Yifan, Li Mingzhe, Chen Ruifang, Yang Gaiqing, Liu Xin, Wang Runqing, Jia Xinzhou, Bu Shufang, Ma Dongpu, Wang Baoyu, Li Shize

机构信息

Department of Neurology, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, Henan Province, China.

Emergency Department, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, Henan Province, China.

出版信息

J Stroke Cerebrovasc Dis. 2017 Oct;26(10):2383-2386. doi: 10.1016/j.jstrokecerebrovasdis.2017.05.029. Epub 2017 Jun 16.

DOI:10.1016/j.jstrokecerebrovasdis.2017.05.029

PMID:28624140

Abstract

BACKGROUND

Whether nonintracranial hemorrhage (NICH) associated with intravenous thrombolysis (IVT) is a predictor of intracranial hemorrhage (ICH) and poor prognosis is ambiguous. We sought to analyze the rate of NICH and the relationship between NICH and poor outcome in the ischemic stroke population undergoing IVT.

METHODS

This is a single-center, hospital-based prospective study. All ischemic stroke patients undergoing IVT between December 2015 and November 2016 were included. NICH was defined according to the criteria of the Bleeding Academic Research Consortium (BARC). ICH associated with IVT was defined based on the European Cooperative Acute Stroke Study II definition. On the basis of the modified Rankin Scale (mRS), 90-day outcome was divided into favorable outcome (mRS score 0-1) versus unfavorable outcome (mRS score 2-6) and independency (mRS score 0-2) versus dependency and death (mRS score 3-6).

RESULTS

A total of 212 patients undergoing IVT were included in the analysis. Forty-five NICH events were reported in 42 patients (19.8%). Older age was independently associated with NICH (P = .049, odds ratio [OR] = .97, 95% confidence interval [CI] .94-1.0). Neither NICH with BARC class 1 or higher (P = .56, OR = .61, 95% CI .11-3.24) nor NICH with BARC class 2 or higher (P = .87, OR = 1.19, 95% CI .14-10.23) was associated with ICH. NICH with BARC class 1 or higher was not associated with unfavorable outcome (P = .67, OR = 1.17, 95% CI .56-2.45) and dependence and death (P = .47, OR = .72, 95% CI .30-1.75), neither was NICH with BARC class 2 or higher (P = .97, OR = 1.02, 95% CI .46-2.27 and P = .30, OR = .59, 95% CI .22-1.62).

CONCLUSIONS

NICH was common among ischemic stroke populations receiving IVT. NICH with BARC class 2 or lower was not associated with ICH and poor outcome.

摘要

背景

与静脉溶栓（IVT）相关的非颅内出血（NICH）是否为颅内出血（ICH）及预后不良的预测因素尚不明确。我们旨在分析接受IVT的缺血性卒中患者中NICH的发生率以及NICH与不良预后之间的关系。

方法

这是一项基于医院的单中心前瞻性研究。纳入2015年12月至2016年11月期间所有接受IVT的缺血性卒中患者。NICH根据出血学术研究联盟（BARC）的标准定义。与IVT相关的ICH根据欧洲急性卒中协作研究II的定义确定。基于改良Rankin量表（mRS），将90天预后分为良好预后（mRS评分0 - 1）与不良预后（mRS评分2 - 6）以及独立（mRS评分0 - 2）与依赖和死亡（mRS评分3 - 6）。

结果

共有212例接受IVT的患者纳入分析。42例患者（19.8%）报告发生45次NICH事件。年龄较大与NICH独立相关（P = 0.049，比值比[OR] = 0.97，95%置信区间[CI] 0.94 - 1.0）。BARC 1级或更高等级的NICH（P = 0.56，OR = 0.61，95% CI 0.11 - 3.24）以及BARC 2级或更高等级的NICH（P = 0.87，OR = 1.19，95% CI 0.14 - 10.23）均与ICH无关。BARC 1级或更高等级的NICH与不良预后（P = 0.67，OR = 1.17，95% CI 0.56 - 2.45）以及依赖和死亡（P = 0.47，OR = 0.72，95% CI 0.30 - 1.75）均无关，BARC 2级或更高等级的NICH也是如此（P = 0.97，OR = 1.02，95% CI 0.46 - 2.27以及P = 0.30，OR = 0.59，95% CI 0.22 - 1.62）。