Liu Jie, Huang Jiaqi, Xu Huimin, Dai Haibin
Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Neurologist. 2020 Mar;25(2):28-32. doi: 10.1097/NRL.0000000000000261.
Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient.
To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset.
Demographics, onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at a Chinese hospital between January 2013 and August 2016 were retrospectively analyzed. The National Institutes of Health Stroke Scale (NIHSS) score was recorded before thrombolytic therapy, 24 hours after the treatment, and 7 days after the treatment to evaluate the recovery of neurological function. ENI was defined as a ≥4-point decrease in NIHSS score compared with baseline or a score of 0 or 1 at 24 hours and 7 days. A multivariate logistic regression analysis was performed to assess the outcomes.
Of the 209 AIS patients treated by intravenous thrombolysis with rt-PA, low-density lipoprotein (LDL) levels were significantly lower (P<0.05) in patients with ENI. The multivariable analysis showed that non-atrial fibrillation (AF) was independently associated with ENI at 24 hours and 7 days after thrombolysis. An overall 40.3% non-AF patients had ENI 24 hours after thrombolysis (odds ratio=2.501, 95% confidence interval: 1.204-5.198; P=0.014), and 65.9% non-AF patients had ENI 7 days after thrombolysis (odds ratio=2.953, 95% confidence interval: 1.434-6.081; P=0.003). Onset to treatment time was an independent predictor (P<0.05) for ENI at 7 days after thrombolysis. The NIHSS score and diastolic blood pressure on admission were associated with symptomatic intracerebral hemorrhagic transformation.
Non-AF was independently associated with ENI after intravenous thrombolysis in AIS patients, but non-AF was not associated with the occurrence of symptomatic intracerebral hemorrhage. Onset to treatment time was an independent predictor of ENI at 7 days after thrombolysis in AIS patients.
静脉溶栓是急性缺血性卒中（AIS）患者唯一获批的药物治疗方法，但患者对溶栓的即时反应存在差异。
探讨急性缺血性卒中患者在发病4.5小时内接受静脉注射重组组织型纤溶酶原激活剂（rt-PA）治疗后早期神经功能改善（ENI）的相关因素。
回顾性分析2013年1月至2016年8月在中国一家医院接受静脉rt-PA治疗的209例AIS患者的人口统计学资料、发病至治疗时间、危险因素以及临床和实验室数据。在溶栓治疗前、治疗后24小时和治疗后7天记录美国国立卫生研究院卒中量表（NIHSS）评分，以评估神经功能恢复情况。ENI定义为与基线相比NIHSS评分降低≥4分，或在24小时和7天时评分为0或1分。进行多因素逻辑回归分析以评估结果。
在209例接受rt-PA静脉溶栓治疗的AIS患者中，有早期神经功能改善的患者低密度脂蛋白（LDL）水平显著较低（P<0.05）。多变量分析显示，非房颤（AF）与溶栓后24小时和7天的早期神经功能改善独立相关。总体而言，40.3%的非房颤患者在溶栓后24小时有早期神经功能改善（比值比=2.501，95%置信区间：1.204-5.198；P=0.014），65.9%的非房颤患者在溶栓后7天有早期神经功能改善（比值比=2.953，95%置信区间：1.434-6.081；P=0.003）。发病至治疗时间是溶栓后7天早期神经功能改善的独立预测因素（P<0.05）。入院时的NIHSS评分和舒张压与症状性颅内出血转化相关。
非房颤与AIS患者静脉溶栓后的早期神经功能改善独立相关，但非房颤与症状性颅内出血的发生无关。发病至治疗时间是AIS患者溶栓后7天早期神经功能改善的独立预测因素。
