Zhao Guangjian, Huang Tingfen, Zheng Mei, Cui Yansen, Liu Yunyong, Cheng Zhongrong, Wang Ziran
Department of Emergency, Linyi People's Hospital, Linyi, China.
Department of Neurology, Linyi People's Hospital, Linyi, China.
Eur Neurol. 2018;79(1-2):68-73. doi: 10.1159/000485460. Epub 2017 Dec 14.
This study analyzed the efficacy and safety of low-dose and standard-dose alteplase intravenous thrombolytic therapy for acute ischemic stroke (AIS).
Patients with AIS who underwent intravenous alteplase thrombolysis from July 2012 to December 2016 were retrospectively analyzed and correspondingly divided into low-dose (0.6-0.89 mg/kg) group and standard-dose group (0.9 mg/kg) according to alteplase dosage. The clinical outcome was evaluated by modified Rankin Scale (mRS) at 90 days after onset. The safety index was the mortality at 90 days after onset and the incidence of symptomatic intracranial hemorrhage (SICH) within 7 days.
A total of 1,486 patients were included (1,115 cases in low-dose group and 371 cases in standard-dose group). There were no significant differences in baseline data between the 2 groups. As mRS, good outcome rate as well as mortality rate in both groups had no significant difference (36.1 vs. 37.6%; χ2 = 10.882, p = 0.890; 5.5 vs. 7.3%; χ2 = 2.163, p = 0.076), but the incidence of SICH in low-dose group was significantly lower than that of the standard-dose group (2.2 vs. 5.9%; χ2 = 3.157, p = 0.001).
The efficacy of low-dose alteplase intravenous thrombolytic therapy for AIS was equivalent to the standard-dose regimen but with higher safety.
本研究分析了低剂量和标准剂量阿替普酶静脉溶栓治疗急性缺血性卒中（AIS）的疗效和安全性。
回顾性分析2012年7月至2016年12月接受静脉阿替普酶溶栓治疗的AIS患者，并根据阿替普酶剂量相应分为低剂量（0.6 - 0.89 mg/kg）组和标准剂量组（0.9 mg/kg）。在发病后90天通过改良Rankin量表（mRS）评估临床结局。安全指标为发病后90天的死亡率和7天内症状性颅内出血（SICH）的发生率。
共纳入1486例患者（低剂量组1115例，标准剂量组371例）。两组间基线数据无显著差异。就mRS而言，两组的良好结局率以及死亡率均无显著差异（36.1%对37.6%；χ2 = 10.882，p = 0.890；5.5%对7.3%；χ2 = 2.163，p = 0.076），但低剂量组SICH的发生率显著低于标准剂量组（2.2%对5.9%；χ2 = 3.157，p = 0.001）。
低剂量阿替普酶静脉溶栓治疗AIS的疗效与标准剂量方案相当，但安全性更高。
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