From the Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (C.C., M.P., C.L., L.L., A.B.); Public Health Stream, Hunter Medical Research Institute, Newcastle, Australia (M.C., C.O.); Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (X.C., Q.D.); Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China (M.L.); Department of Neurology, Royal Adelaide Hospital, Australia (T.K.); and Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (K.B.).
Stroke. 2017 Oct;48(10):2739-2745. doi: 10.1161/STROKEAHA.117.018587. Epub 2017 Sep 8.
In alteplase-treated patients with acute ischemic stroke, we investigated the relationship between penumbral reperfusion at 24 hours and clinical outcomes, with and without adjustment for baseline ischemic core volume.
Data were collected from consecutive acute ischemic stroke patients with baseline and follow-up perfusion imaging presenting to hospital within 4.5 hours of symptom onset at 7 hospitals. Logistic regression models were used for predicting the effect of the reperfused penumbral volume on the dichotomized modified Rankin Scale (mRS) at 90 days and improvement of National Institutes of Health Stroke Scale at 24 hours, both adjusted for baseline ischemic core volume.
This study included 1507 patients. Reperfused penumbral volume had moderate ability to predict 90-day mRS 0 to 1 (area under the curve, 0.77; , 0.28; <0.0001). However, after adjusting for baseline ischemic core volume, the reperfused penumbral volume was a strong predictor of good functional outcome (area under the curve, 0.946; , 0.55; <0.0001). For every 1% increase in penumbral reperfusion, the odds of achieving mRS 0 to 1 at day 90 increased by 7.4%. Improvement in acute 24-hour National Institutes of Health Stroke Scale was also significantly related to the degree of reperfused penumbra (, 0.31; P<0.0001). This association was again stronger after adjustment for baseline ischemic core volume (, 0.41; <0.0001). For each 1% of penumbra that was reperfused, the 24-hour National Institutes of Health Stroke Scale decreased by 0.069 compared with baseline.
In patients treated with alteplase, the extent of the penumbra that is reperfused is a powerful predictor of early and late clinical outcomes, particularly when baseline ischemic core is taken into account.
在接受阿替普酶治疗的急性缺血性脑卒中患者中，我们研究了 24 小时时缺血半暗带再灌注与临床结局之间的关系，同时调整了基线缺血核心体积。
本研究的数据来自 7 家医院在症状发作后 4.5 小时内连续收治的具有基线和随访灌注成像的急性缺血性脑卒中患者。使用逻辑回归模型预测再灌注缺血半暗带体积对 90 天时改良 Rankin 量表（mRS）的二分法和 24 小时时国立卫生研究院卒中量表的改善的影响，均调整了基线缺血核心体积。
这项研究共纳入了 1507 例患者。再灌注缺血半暗带体积对 90 天 mRS 0-1 具有中等的预测能力（曲线下面积，0.77；95%置信区间，0.28；<0.0001）。然而，在调整了基线缺血核心体积后，再灌注缺血半暗带体积是良好功能结局的强预测因素（曲线下面积，0.946；95%置信区间，0.55；<0.0001）。每增加 1%的缺血半暗带再灌注，90 天时达到 mRS 0-1 的几率增加 7.4%。急性 24 小时国立卫生研究院卒中量表的改善也与再灌注缺血半暗带的程度显著相关（，0.31；P<0.0001）。在调整了基线缺血核心体积后，这种关联更强（，0.41；<0.0001）。与基线相比，每再灌注 1%的缺血半暗带，24 小时国立卫生研究院卒中量表下降 0.069。
在接受阿替普酶治疗的患者中，再灌注缺血半暗带的范围是早期和晚期临床结局的有力预测因素，尤其是当考虑到基线缺血核心时。
