Chenna Vijay, Kaul Subhash, Tandra Swetha, Yareeda Sireesha, Mathukumalli Neeharika, Kohat Abhijeet Kumar, Kandadai Rukmini Mridula, Turaga Suryaprabha, Sheik Jabeen Afshan, Meena A K, Borgohain Rupam
Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Ann Indian Acad Neurol. 2018 Jul-Sep;21(3):214-219. doi: 10.4103/aian.AIAN_228_17.
Symptomatic Intracerebral hemorrhage (sICH) is a serious complication of recombinant tissue-plasminogen activator (rt-PA) therapy for acute ischemic stroke (AIS).
To estimate the prevalence and predictors of sICH in patients after receiving IV rt-PA for AIS.
Consecutive patients of AIS thrombolysed between January 2010 and June 2016 in a University hospital in Hyderabad (India) were studied prospectively for sICH and it's various variables compared with the control group without sICH to determine any sigificantant difference.
Out of 113 patients , sICH was detected in 12 (10.61%) whose mean age(58±12.0 years) and gender ratio ( 2:1 ) was not statistically significant from controls. In s ICH group mean NIHSS score was 16.53± 5.81 vs 10.19± 5.06 in controls (<0.001), gap between stroke onset and thrombolysis was 227.50±46.15 min vs 178.50± 69.20 min in controls(=0.018). At presentation mean blood sugar was 208.75±90.97 mg/dl in sICH group vs 146.83±70.21 mg/dl in controls (=0.002). Prior diabetes was in 7(53.30%) vs 23 (22.8%) in controls (= 0.014)and hypertension in 11 (91.7%) vs (56(55.4%) in controls (= 0.026) The mortality in sICH was 7 (58.30%)vs 4 (4.94%) in controls (<.0.001). At 3 months mean mRS ofsICH patients was 5.57± 0.54 vs 2.17± 1.69 in controls (<.05).
High NIHSS score, increased stroke onset to thrombolysis time , high blood sugar at presentation ,prior diabetes and hypertension increase the chances of sICH. None of these contraindicate thrombolysing strokes but should caution the physician.
症状性脑出血（sICH）是重组组织型纤溶酶原激活剂（rt-PA）治疗急性缺血性卒中（AIS）的严重并发症。
评估接受静脉rt-PA治疗AIS患者中sICH的发生率及预测因素。
对2010年1月至2016年6月在印度海得拉巴一家大学医院接受溶栓治疗的连续AIS患者进行前瞻性研究，观察sICH及其各种变量，并与无sICH的对照组进行比较，以确定是否存在显著差异。
113例患者中，12例（10.61%）检测到sICH，其平均年龄（58±12.0岁）和性别比（2:1）与对照组相比无统计学差异。sICH组的美国国立卫生研究院卒中量表（NIHSS）平均评分为16.53±5.81，而对照组为10.19±5.06（<0.001）；卒中发作至溶栓的间隔时间在sICH组为227.50±46.15分钟，对照组为178.50±69.20分钟（=0.018）。就诊时sICH组的平均血糖为208.75±90.97mg/dl，对照组为146.83±70.21mg/dl（=0.002）。既往糖尿病患者在sICH组为7例（53.30%），对照组为23例（22.8%）（=0.014）；高血压患者在sICH组为11例（91.7%），对照组为56例（55.4%）（=0.026）。sICH患者的死亡率为7例（58.30%），对照组为4例（4.94%）（<0.001）。3个月时，sICH患者的改良Rankin量表（mRS）平均评分为5.57±0.54，对照组为2.17±1.69（<0.05）。
高NIHSS评分、卒中发作至溶栓时间延长、就诊时高血糖、既往糖尿病和高血压会增加sICH的发生几率。这些因素均不构成溶栓治疗卒中的禁忌证，但应引起医生的注意。
