成人人类免疫缺陷病毒感染患者中风及疑似中风的静脉溶栓治疗：一项美国多中心回顾性研究
Intravenous Thrombolysis for Stroke and Presumed Stroke in Human Immunodeficiency Virus-Infected Adults: A Retrospective, Multicenter US Study.
作者信息
AbdelRazek Mahmoud A, Gutierrez Jose, Mampre David, Cervantes-Arslanian Anna, Ormseth Cora, Haussen Diogo, Thakur Kiran T, Lyons Jennifer L, Smith Bryan R, O'Connor Owen, Willey Joshua Z, Mateen Farrah J
机构信息
From the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (M.A.A., O.O., F.J.M.); Department of Neurology, Columbia University Medical Center, New York, NY (J.G., K.T.T., J.Z.W.); Department of Neurology, Yale-New Haven Hospital, CT (D.M., C.O.); Department of Neurology, Boston University School of Medicine, MA (A.C.-A.); Department of Neurology, University of Miami Hospital, FL (D.H.); Department of Neurology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA (J.L.L.); and Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, Bethesda, MD (B.R.S.).
出版信息
Stroke. 2018 Jan;49(1):228-231. doi: 10.1161/STROKEAHA.117.019570.
BACKGROUND AND PURPOSE
Human immunodeficiency virus (HIV) infection has been shown to increase both ischemic and hemorrhagic stroke risks, but there are limited data on the safety and outcomes of intravenous thrombolysis with tPA (tissue-type plasminogen activator) for acute ischemic stroke in HIV-infected patients.
METHODS
A retrospective chart review of intravenous tPA-treated HIV patients who presented with acute stroke symptoms was performed in 7 large inner-city US academic centers (various search years between 2000 and 2017). We collected data on HIV, National Institutes of Health Stroke Scale score, ischemic stroke risk factors, opportunistic infections, intravenous drug abuse, neuroimaging findings, and modified Rankin Scale score at last follow-up.
RESULTS
We identified 33 HIV-infected patients treated with intravenous tPA (mean age, 51 years; 24 men), 10 of whom were stroke mimics. Sixteen of 33 (48%) patients had an HIV viral load less than the limit of detection while 10 of 33 (30%) had a CD4 count <200/mm. The median National Institutes of Health Stroke Scale score at presentation was 9, and mean time from symptom onset to tPA was 144 minutes (median, 159). The median modified Rankin Scale score for the 33-patient cohort was 1 and for the 23-patient actual stroke cohort was 2, measured at a median of 90 days poststroke symptom onset. Two patients had nonfatal hemorrhagic transformation (6%; 95% confidence interval, 1%-20%), both in the actual stroke group. Two patients had varicella zoster virus vasculitis of the central nervous system, 1 had meningovascular syphilis, and 7 other patients were actively using intravenous drugs (3 cocaine, 1 heroin, and 3 unspecified), none of whom had hemorrhagic transformation.
CONCLUSIONS
Most HIV-infected patients treated with intravenous tPA for presumed and actual acute ischemic stroke had no complications, and we observed no fatalities. Stroke mimics were common, and thrombolysis seems safe in this group. We found no data to suggest an increased risk of intravenous tPA-related complications because of concomitant opportunistic infections or intravenous drug abuse.
背景与目的
已表明人类免疫缺陷病毒（HIV）感染会增加缺血性和出血性中风的风险，但关于HIV感染患者急性缺血性中风使用组织型纤溶酶原激活剂（tPA）进行静脉溶栓的安全性和预后的数据有限。
方法
在美国7个大型市中心学术中心（2000年至2017年期间不同的检索年份）对出现急性中风症状且接受静脉tPA治疗的HIV患者进行回顾性病历审查。我们收集了有关HIV、美国国立卫生研究院卒中量表评分、缺血性中风危险因素、机会性感染、静脉药物滥用、神经影像学检查结果以及最后一次随访时改良Rankin量表评分的数据。
结果
我们确定了33例接受静脉tPA治疗的HIV感染患者（平均年龄51岁；24例男性），其中10例为疑似中风。33例患者中有16例（48%）的HIV病毒载量低于检测限，33例中有10例（30%）的CD4细胞计数<200/mm³。就诊时美国国立卫生研究院卒中量表评分的中位数为9分，从症状发作到使用tPA的平均时间为144分钟（中位数为159分钟）。33例患者队列的改良Rankin量表评分中位数为1分，23例实际中风患者队列的评分为2分，在中风症状发作后中位数90天时进行测量。2例患者发生非致命性出血转化（6%；95%置信区间为1% - 20%），均在实际中风组。2例患者患有中枢神经系统水痘带状疱疹病毒血管炎，1例患有脑膜血管梅毒，另外7例患者正在积极使用静脉药物（3例使用可卡因，1例使用海洛因，3例未明确），这些患者均未发生出血转化。
结论
大多数因疑似和实际急性缺血性中风接受静脉tPA治疗的HIV感染患者无并发症，且我们未观察到死亡病例。疑似中风很常见，溶栓在该组中似乎是安全的。我们未发现数据表明因合并机会性感染或静脉药物滥用而增加静脉tPA相关并发症的风险。
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