Sadeghi-Hokmabadi Elyar, Yazdchi Mohammad, Farhoudi Mehdi, Sadeghi Homayoun, Taheraghdam Aliakbar, Rikhtegar Reza, Aliyar Hannaneh, Mohammadi-Fallah Sahar, Asadi Rogayyeh, Mehdizadeh-Far Elham, Ghaemian Neda
Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
Iran J Neurol. 2018 Jan 5;17(1):31-37.
Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA. A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality. Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. Any type of hemorrhage, symptomatic hemorrhage [based on the European Cooperative Acute Stroke Study III (ECASS III) definition] within 24 hours posttreatment, poor 3-month outcome (mRS 3-6), and 3-month mortality were documented in 10.6%, 4.5%, 53.2%, and 23.6% of patients, respectively. Increased baseline blood glucose was a significant but dependent predictor of hemorrhage within the first 24 hours posttreatment. Dependent predictors of a 3-month poor outcome were high age, the National Institutes of Health Stroke Scale (NIHSS) at baseline, decreased admitting glomerular filtration rate (GFR), and the presence of atrial fibrillation (AF) rhythm, and ICH within 24 hours posttreatment. Only age [Odds ratio (OR) adjusted 1.05] and initial NIHSS (OR adjusted 1.23), however, were recognized as the independent variables in this regard. The only independent predictor of 3-month mortality was the initial NIHSS (OR adjusted 1.18). According to the findings of the present study, advanced age and high baseline NIHSS are two independent prognostic factors in patients with AIS treated with tPA.
组织型纤溶酶原激活剂（tPA）长期以来一直被批准用于急性缺血性卒中（AIS）患者的有效治疗；然而，由于一些严重并发症，尤其是颅内出血（ICH），许多医生仍然不愿意广泛使用它。本研究旨在寻找接受tPA治疗的AIS患者的潜在预后因素。进行了一项基于医院的回顾性观察研究。连续纳入了2011年6月至2015年7月期间共132例接受静脉tPA治疗的AIS患者。纳入和排除标准基于最新指南。在三个不同组中分别检查可能的预后变量；治疗后24小时内ICH的发生情况、基于改良Rankin量表（mRS）的3个月不良结局以及3个月死亡率。患者中有83名男性（62.9%）和49名女性（37.1%），中位年龄为66岁[四分位间距（IQR）为55 - 72]。分别有10.6%、4.5%、53.2%和23.6%的患者记录了任何类型的出血、治疗后24小时内的症状性出血[基于欧洲急性卒中协作研究III（ECASS III）定义]、3个月不良结局（mRS 3 - 6）以及3个月死亡率。治疗后最初24小时内，基线血糖升高是出血的一个显著但相关的预测因素。3个月不良结局的相关预测因素包括高龄、基线时的美国国立卫生研究院卒中量表（NIHSS）评分、入院时肾小球滤过率（GFR）降低、心房颤动（AF）心律以及治疗后24小时内的ICH。然而，在这方面只有年龄[比值比（OR）调整后为1.05]和初始NIHSS（OR调整后为1.23）被视为独立变量。3个月死亡率的唯一独立预测因素是初始NIHSS（OR调整后为1.18）。根据本研究的结果，高龄和高基线NIHSS是接受tPA治疗的AIS患者的两个独立预后因素。
