Xu Xiaomeng, Wang Deren, Wang Fang, Norton Casey, Liu Xinfeng, Selim Magdy
Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2381-2387. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.027. Epub 2018 May 31.
There is a widespread belief that Asians are more susceptible to hemorrhagic transformation (HT) after receiving recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke (AIS). However, this has not been examined in clinical practice. This study aims to compare the incidence of symptomatic hemorrhagic transformation (SHT) among thrombolysis-treated AIS patients in China and in the United States.
We compared 212 consecutive patients receiving thrombolysis within 4.5 hours of onset ± endovascular therapy from an American (n = 86) and a Chinese Stroke Center (n = 126). SHT was defined using various definitions based on the National Institute for Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator (NINDS rt-PA) trials, European-Australian Cooperative Acute Stroke Study 2 (ECASS2), and a modified version of Safe Implementation of Thrombolysis in Stroke-Monitoring Study (mSITS-MOST) study criteria. We used Firth logistic regression to adjust for confounding variables and to identify potential predictors.
American patients were older, and had higher prevalence of diabetes, hypertension, cardiac disease, and prestroke use of antithrombotics. They also had higher baseline serum glucose, shorter onset-to-treatment time, and fewer endovascular treatments. The rates of SHT were higher in the American cohort compared to the Chinese cohort: 18.6% versus 14.3% based on NINDS definition of SHT; 15.1% versus 12.7% based on ECASS2; and 11.6% versus 7.2% based on mSITS-MOST. However, none of these differences were significant (unadjusted and adjusted P values > .05). Fatal HT was comparable in Americans versus Chinese (8.1% versus 8.7%). Serum glucose emerged as an independent predictor of SHT (P = .024).
In our cohorts, the rate of SHT after thrombolysis is equivalent between Chinese and North American stroke patients.
人们普遍认为，亚洲人在接受重组组织型纤溶酶原激活剂（rt-PA）治疗急性缺血性卒中（AIS）后更容易发生出血性转化（HT）。然而，这一点在临床实践中尚未得到检验。本研究旨在比较中国和美国接受溶栓治疗的AIS患者中症状性出血性转化（SHT）的发生率。
我们比较了来自美国（n = 86）和中国一家卒中中心（n = 126）的212例在发病4.5小时内接受溶栓治疗±血管内治疗的连续患者。根据美国国立神经疾病和卒中研究所重组组织型纤溶酶原激活剂（NINDS rt-PA）试验、欧洲-澳大利亚急性卒中合作研究2（ECASS2）以及卒中溶栓安全实施-监测研究（mSITS-MOST）研究标准的修改版，使用多种定义来界定SHT。我们使用Firth逻辑回归来调整混杂变量并识别潜在预测因素。
美国患者年龄更大，糖尿病、高血压、心脏病以及卒中前使用抗栓药物的患病率更高。他们的基线血清葡萄糖水平也更高，发病至治疗时间更短，接受血管内治疗的次数更少。与中国队列相比，美国队列中的SHT发生率更高：根据NINDS对SHT的定义，分别为18.6%和14.3%；根据ECASS2，分别为15.1%和12.7%；根据mSITS-MOST，分别为11.6%和7.2%。然而，这些差异均无统计学意义（未调整和调整后的P值>0.05）。美国人和中国人的致命性HT发生率相当（8.1%对8.7%）。血清葡萄糖是SHT的独立预测因素（P = 0.024）。
在我们的队列中，中国和北美卒中患者溶栓后的SHT发生率相当。
