Zhang Wenwen, Coote Skye, Frost Tanya, Dewey Helen M, Choi Philip M C
Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia.
Department of Neuroscience, Eastern Health, Melbourne, Victoria, Australia.
J Stroke Cerebrovasc Dis. 2018 Oct;27(10):2707-2711. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.051. Epub 2018 Jul 20.
Thrombolytic therapy in patients with pre-existing disability presenting with acute ischemic stroke (AIS) is controversial because of concerns regarding poor outcomes and futility of treatment. We hypothesized that a similar proportion of patients with and without pre-existing disability would return to their premorbid functional status following thrombolysis.
This was a retrospective study at a single high-volume academic primary stroke center. All patients with AIS treated with intravenous alteplase between January 2005 and July 2016 were included. Premorbid functional status was assessed using modified Rankin scale (mRS) and dichotomized as independent premorbid (mRS 0-1) or disabled premorbid (mRS 2-4) groups for comparison. Functional outcome was assessed by mRS at 90 days and compared between groups.
Six hundred eighty patients independent premorbid (mean age 71.8 ± 13.1 years, 57.9% male) and 140 disabled premorbid (mean age 82.1 ± 8.7 years, 40.7% male) were included. Patients with pre-existing disability were older and had more vascular risk factors and more severe stroke on presentation (P < 0.05). A greater proportion of patients in the disabled premorbid group were dead at 90 days (35.7% versus 12.8%, P < 0.05). At 90 days, among patients with premorbid mRS 0, 1, 2, 3, and 4: 25%, 38%, 32%, 30%, and 25% of them returned to their respective premorbid mRS status.
Irrespective of premorbid functional level, approximately one fourth to one third of thrombolyzed patients had returned to their premorbid functional levels at 90 days. Thrombolytic treatment should be considered in patients with mild-to-moderate pre-existing disability, taking into account the value placed on the chance of a return to premorbid functional status.
对于已有残疾的急性缺血性卒中（AIS）患者，溶栓治疗存在争议，因为人们担心其预后不佳且治疗无效。我们假设，溶栓后有和没有已有残疾的患者恢复到病前功能状态的比例相似。
这是一项在一个高流量学术性初级卒中中心进行的回顾性研究。纳入了2005年1月至2016年7月期间所有接受静脉注射阿替普酶治疗的AIS患者。使用改良Rankin量表（mRS）评估病前功能状态，并将其分为病前独立（mRS 0 - 1）或病前残疾（mRS 2 - 4）两组进行比较。在90天时通过mRS评估功能结局并在组间进行比较。
纳入了680例病前独立患者（平均年龄71.8±13.1岁，男性占57.9%）和140例病前残疾患者（平均年龄82.1±8.7岁，男性占40.7%）。已有残疾的患者年龄更大，有更多血管危险因素，且发病时卒中更严重（P<0.05）。病前残疾组在90天时死亡的患者比例更高（35.7%对12.8%，P<0.05）。在90天时，病前mRS为0、1、2、3和4的患者中，分别有25%、38%、32%、30%和25%恢复到各自的病前mRS状态。
无论病前功能水平如何，约四分之一至三分之一的溶栓患者在90天时恢复到了病前功能水平。对于轻度至中度已有残疾的患者，应考虑溶栓治疗，同时要考虑到恢复到病前功能状态的可能性的价值。
