Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Neurology, Yang-Si Hospital, Shanghai, China.
Neurol Res. 2021 Aug;43(8):653-658. doi: 10.1080/01616412.2021.1908672. Epub 2021 Apr 13.
The evidence of rt-PA intravenous thrombolysis in patients with minor ischemic stroke (MIS) is still controversial. This study aims to investigate the effect of rt-PA intravenous thrombolysis on the prognosis of patients with MIS.
We continuously enrolled and analyzed patients with MIS admitted into our hospital within 24 h after symptom onset between January 2016 and December 2018, including 96 patients received intravenous thrombolysis within 4.5 h after symptom onset and 84 patients not received intravenous thrombolysis. A favorable long-term outcome was a 90-day mRS score of 0-1. Good short-term outcome was a 7-day NIHSS score of 0 or less than NIHSS onset.
There were no statistical differences between two groups of patients' age, gender, history of hypertension, coronary heart disease, atrial fibrillation, smoking, drinking, and baseline NIHSS score. Patients with history of stroke (22.62% vs. 10.42%, < 0.05) and diabetes (46.43% vs. 22.92%, = 0.01) were higher in group of non-thrombolysis. The difference of NIHSS score after 7 days was statistically different between the two groups ( < 0.05), while there was no significant difference in 90-day mRS score. Logistic regression analysis indicated that the prognosis of patients was correlated with neutrophil ratio and CRP at admission.
Patients with MIS received intravenous thrombolysis may be associated with earlier neurological improvement, but might has no significant effect on long-term prognosis. The level of neutrophil ratio and CRP at admission are risk factors determining the prognosis, which requires further research.
阿替普酶静脉溶栓治疗轻度缺血性卒中(MIS)的证据仍存在争议。本研究旨在探讨阿替普酶静脉溶栓对 MIS 患者预后的影响。
连续纳入 2016 年 1 月至 2018 年 12 月发病 24 小时内的 MIS 患者,发病 4.5 小时内接受静脉溶栓的患者 96 例,未接受静脉溶栓的患者 84 例。90 天 mRS 评分 0~1 分为预后良好,7 天 NIHSS 评分 0 分或较基线下降≥4 分为短期预后良好。
两组患者的年龄、性别、高血压史、冠心病史、心房颤动史、吸烟史、饮酒史、基线 NIHSS 评分差异无统计学意义。溶栓组患者的卒中史(22.62%比 10.42%, < 0.05)和糖尿病史(46.43%比 22.92%, = 0.01)高于未溶栓组。两组患者的 7 天 NIHSS 评分差值差异有统计学意义( < 0.05),90 天 mRS 评分差异无统计学意义。Logistic 回归分析显示,患者的预后与入院时的中性粒细胞比率和 CRP 水平有关。
MIS 患者接受静脉溶栓治疗可能与更早的神经功能改善有关,但对长期预后无显著影响。入院时的中性粒细胞比率和 CRP 水平是决定预后的危险因素,需要进一步研究。