急性缺血性卒中的溶栓门到针时间与病死率和致残率：一项来自中国卒中大数据观测平台的研究

Thrombolytic DNT and fatality and disability rates in acute ischemic stroke: a study from Bigdata Observatory Platform for Stroke of China.

作者信息

Tu Wen-Jun, Yan Feng, Chao Bao-Hua, Ma Lin, Ji Xun-Ming, Wang Long-De

机构信息

The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, No. 118, Guang'anmen Inner Street, Beijing, 100053, China.

Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300192, China.

出版信息

Neurol Sci. 2022 Jan;43(1):677-682. doi: 10.1007/s10072-021-05580-w. Epub 2021 Sep 3.

DOI:10.1007/s10072-021-05580-w

PMID:34480243

Abstract

OBJECTIVE

To evaluate whether shorter door-to-needle times (DNT) with intravenous tissue plasminogen activator (tPA) for acute ischemic stroke are associated with improved 1-year outcomes in Chinese patients.

METHODS

From August to September 2019, all first-ever ischemic stroke patients who were treated with intravenous tPA within 4.5 h of the time they were last known to be well from 232 hospitals in China were included. Patients were divided into four groups according to DNT time (≤ 45 min; 45-60 min; 60-90 min; > 90 min). All discharged patients would receive a telephone follow-up at 12-month after admission. Death and disability events were recorded.

RESULTS

Finally, 2370 patients were analyzed. The median age was 65 years, 66.6% were male, and 2.4% were of ethnic minorities. In the 1-year follow-up, 211 patients died (8.9%; 95%CI: 7.8-10.0%). The patients (53.1%) had DNT times of longer than 45 min, compared with those treated within 45 min, did not have significantly higher 1-year mortality (8.9% vs 8.9% [absolute difference, 0.03% {95% CI, - 0.05% to - 0.10%}, odd ratio {OR}, 1.00 {95% CI, 0.75 to 1.33}]). In addition, 385 patients (16.2%; 14.8-17.3%) out of those survivors had disability events. The patients had DNT times of longer than 45 min, compared with those treated within 45 min, did not have significantly higher 1-year disability rate (18.9% vs 16.7% [absolute difference, 1.9% {95% CI, 1.1% to 3.0%}, odd ratio {OR}, 1.22 {95% CI, 0.89 to 1.43}]).

CONCLUSIONS

The results did not show that shorter DNT for tPA administration was significantly associated with better 1-year outcomes.

摘要

目的

评估中国急性缺血性卒中患者静脉注射组织型纤溶酶原激活剂（tPA）时缩短从入院到用药时间（DNT）是否与1年预后改善相关。

方法

纳入2019年8月至9月期间在中国232家医院首次发生缺血性卒中且在最后一次已知健康状态后的4.5小时内接受静脉tPA治疗的所有患者。根据DNT时间将患者分为四组（≤45分钟；45 - 60分钟；60 - 90分钟；>90分钟）。所有出院患者在入院后12个月接受电话随访。记录死亡和残疾事件。

结果

最终分析了2370例患者。中位年龄为65岁，男性占66.6%，少数民族占2.4%。在1年随访中，211例患者死亡（8.9%；95%置信区间：7.8 - 10.0%）。DNT时间超过45分钟的患者（53.1%）与在45分钟内接受治疗的患者相比，1年死亡率没有显著更高（8.9%对8.9%[绝对差异，0.03%{95%置信区间， - 0.05%至 - 0.10%}，比值比{OR}，1.00{95%置信区间，0.75至1.33}]）。此外，在这些幸存者中，385例患者（16.2%；14.8 - 17.3%）发生了残疾事件。DNT时间超过45分钟的患者与在45分钟内接受治疗的患者相比，1年残疾率没有显著更高（18.9%对16.7%[绝对差异，1.9%{95%置信区间，1.1%至3.0%}，比值比{OR}，1.22{95%置信区间，0.89至1.43}]）。