Lee Xian-Ru, Xiang Gui-Ling
Departments of Neurosurgery, The Ningbo First Hospital, Ningbo, Zhejiang, 315010, PR China.
Departments of Respiratory Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266003, PR China.
Clin Neurol Neurosurg. 2018 Apr;167:157-161. doi: 10.1016/j.clineuro.2018.02.026. Epub 2018 Feb 24.
Edaravone, a free radical scavenger, alleviates blood-brain barrier disruption in conjunction with suppression of the inflammatory reaction in acute cerebral infarction. Thrombolysis with recombinant tissue plasminogen activator (rtPA) is an established therapy for acute cerebral infarction patients. The purpose of this study was to assess the effects of edaravone on outcomes in acute cerebral infarction patients treated with ultra-early thrombolysis of iv-rt-PA.
We conducted a retrospective cohort study using the database of Ningbo First Hospital. We identified patients who were admitted with a primary diagnosis of acute cerebral infarction and treated with intravenous rtPA(iv-rtPA) within 3 h of symptom onset from March 1st in 2014 to October 31st in 2016.Thenceforth,the patients were divided into 2 groups by treatment with(edaravone group) or without edaravone(non-edaravone group). Glasgow Coma Scale (GCS) scores and mRS score at admission were used. Clinical background, risk factors for acute cerebral infarction hemorrhagic transformation, 7-day mortality, recanalization rate, bleeding complications and blood rheology indexes were collected. We also collected the following factors: National Institutes of Health Stroke Scale scores, barthel index.
136 patients treated without edaravone during hospitalization were selected in non-edaravone group while edaravone group included 132 patients treated with edaravone during hospitalization. The patient baseline distributions were well balanced between non-edaravone group and edaravone group. The rate of hemorrhagic transformation in non-edaravone group was higher than that in edaravone group (P ＜ 0.05). The NIHSS scores 7 days and 14 days after symptom onset were higher in non-edaravone group than in edaravone group (both P ＜ 0.05). Edaravone group showed a higher recanalization rate and a lower bleeding complications rate at discharge than the non-edaravone group (both P ＜ 0.05). The differences of all the blood rheology indexes between the two groups were statistically significant (all P ＜ 0.05).
Edaravone may improve outcomes of acute cerebral infarction patients treated with ultra-early thrombolysis of iv-rt-PA.
依达拉奉是一种自由基清除剂，可减轻急性脑梗死时血脑屏障的破坏，并抑制炎症反应。重组组织型纤溶酶原激活剂（rtPA）溶栓是急性脑梗死患者的既定治疗方法。本研究旨在评估依达拉奉对接受静脉注射rt-PA超早期溶栓治疗的急性脑梗死患者预后的影响。
我们使用宁波市第一医院的数据库进行了一项回顾性队列研究。我们纳入了2014年3月1日至2016年10月31日期间因急性脑梗死入院并在症状发作后3小时内接受静脉rtPA（iv-rtPA）治疗的患者。此后，根据是否接受依达拉奉治疗（依达拉奉组）将患者分为两组（非依达拉奉组）。使用入院时的格拉斯哥昏迷量表（GCS）评分和改良Rankin量表（mRS）评分。收集临床背景、急性脑梗死出血转化的危险因素、7天死亡率、再通率、出血并发症和血液流变学指标。我们还收集了以下因素：美国国立卫生研究院卒中量表评分、巴氏指数。
非依达拉奉组选择了136例住院期间未接受依达拉奉治疗的患者，依达拉奉组包括132例住院期间接受依达拉奉治疗的患者。非依达拉奉组和依达拉奉组的患者基线分布均衡。非依达拉奉组的出血转化率高于依达拉奉组（P＜0.05）。症状发作后7天和14天，非依达拉奉组的美国国立卫生研究院卒中量表评分高于依达拉奉组（均P＜0.05）。依达拉奉组出院时的再通率较高，出血并发症发生率较低，均高于非依达拉奉组（均P＜0.05）。两组所有血液流变学指标的差异均有统计学意义（均P＜0.05）。
依达拉奉可能改善接受静脉注射rt-PA超早期溶栓治疗的急性脑梗死患者的预后。
