Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan.
J Thromb Thrombolysis. 2020 May;49(4):545-550. doi: 10.1007/s11239-019-02015-4.
Early neurological deterioration (END) following intravenous recombinant tissue plasminogen activator (rt-PA) treatment is a serious clinical event that can be caused by hemorrhagic or ischemic insult. We investigated the differences in predictive factors for END due to hemorrhagic and END due to ischemic insults. Consecutive patients from four hospitals who received 0.6 mg/kg intravenous rt-PA for acute ischemic stroke were retrospectively recruited. END was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within 24 h compared with baseline. END was classified into those due to hemorrhagic (END) or ischemic (END) insult based on computed tomography (CT) or magnetic resonance imaging. Risk factors associated with END and END were investigated by comparison with non-END cases. A total of 744 patients (452 men, median 75 years old) were included. END was observed in 79 patients (10.6%), including 22 END (3.0%) and 57 END (7.7%), which occurred within a median of 7 h after treatment. Multivariate analyses showed that higher pretreatment NIHSS score (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.00-1.13) and pretreatment with antiplatelets (OR 2.84, 95% CI 1.08-7.72) were associated with END. Extensive early ischemic change (Alberta Stroke Program Early CT Score ≤ 7 on CT or ≤ 6 on diffusion-weighted imaging; OR 2.80, 95% CI 1.36-5.64) and large artery occlusions (OR 3.09, 95% CI 1.53-6.57) were associated with END. Distinct factors were predictive for the END subtypes. These findings could help develop preventative measures for END in patients with the identified risk factors.
早期静脉重组组织型纤溶酶原激活物（rt-PA）治疗后出现神经功能恶化（END）是一种严重的临床事件，可由出血性或缺血性损伤引起。我们研究了出血性 END 和缺血性 END 的预测因素的差异。连续从四家医院接受 0.6mg/kg 静脉 rt-PA 治疗的急性缺血性脑卒中患者被回顾性招募。END 定义为与基线相比 24 小时内 NIHSS 评分≥4 分。根据计算机断层扫描（CT）或磁共振成像将 END 分为出血性（END）或缺血性（END）损伤。通过与非 END 病例进行比较，研究与 END 和 END 相关的危险因素。共纳入 744 例患者（452 例男性，中位年龄 75 岁）。79 例患者发生 END（10.6%），其中 22 例为 END（3.0%），57 例为 END（7.7%），中位发生时间为治疗后 7 小时内。多变量分析显示，较高的治疗前 NIHSS 评分（优势比[OR] 1.06，95%置信区间[CI] 1.00-1.13）和治疗前使用抗血小板药物（OR 2.84，95% CI 1.08-7.72）与 END 相关。广泛的早期缺血性改变（CT 上 Alberta 脑卒中项目早期 CT 评分≤7 或弥散加权成像上≤6；OR 2.80，95% CI 1.36-5.64）和大动脉闭塞（OR 3.09，95% CI 1.53-6.57）与 END 相关。不同的因素对 END 亚型有预测作用。这些发现有助于针对确定的危险因素的患者制定 END 的预防措施。
