静脉溶栓改善急性缺血性脑卒中合并慢性肾脏病患者的预后。
Intravenous Thrombolysis Improves the Prognosis of Patients with Acute Ischemic Stroke and Chronic Kidney Disease.
机构信息
Department of Neurology, Jingjiang People's Hospital, Seventh Affiliated Hospital of Yangzhou University, Jiangsu.
Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing.
出版信息
J Emerg Med. 2022 Aug;63(2):232-239. doi: 10.1016/j.jemermed.2022.05.013. Epub 2022 Aug 11.
BACKGROUND
Chronic kidney disease (CKD) is associated with a higher mortality rate and a poor prognosis among patients with acute ischemic stroke (AIS) who receive intravenous thrombolysis (IVT); however, it is still unclear whether IVT improves the prognosis of patients with AIS and CKD.
OBJECTIVE
We conducted this study to evaluate the impact of IVT in patients with AIS and CKD.
METHODS
We analyzed patients with AIS and CKD in 3 stroke centers who met the indications for IVT between January 2015 and January 2020. The patients were grouped into an IVT group and a non-IVT group according to whether patients received IVT. After propensity score matching at a 1:1 ratio, symptomatic intracranial hemorrhage (sICH) and the modified Rankin Scale (mRS) score at 3 months were compared to assess the safety and efficacy of IVT in patients with AIS with CKD.
RESULTS
A total of 888 patients were enrolled: 763 in the IVT group and 125 in the non-IVT group. After matching, 250 patients were analyzed, and no significant differences were found in sICH between the 2 groups. However, the IVT group had a better 90-day mRS (0-2) score (70.4% vs. 57.6; p = 0.048) than the non-IVT group.
CONCLUSIONS
IVT improved the 3-month prognosis and did not increase the occurrence of sICH among patients with AIS with CKD.
背景
慢性肾脏病（CKD）与接受静脉溶栓（IVT）的急性缺血性脑卒中（AIS）患者的死亡率和预后不良相关；然而，IVT 是否改善 AIS 和 CKD 患者的预后仍不清楚。
目的
我们进行这项研究来评估 IVT 对 AIS 和 CKD 患者的影响。
方法
我们分析了 2015 年 1 月至 2020 年 1 月期间 3 个卒中中心符合 IVT 适应证的 AIS 和 CKD 患者。根据患者是否接受 IVT，将患者分为 IVT 组和非-IVT 组。以 1:1 的比例进行倾向评分匹配后，比较症状性颅内出血（sICH）和改良 Rankin 量表（mRS）评分在 3 个月时，以评估 IVT 在 AIS 合并 CKD 患者中的安全性和疗效。
结果
共纳入 888 例患者：IVT 组 763 例，非-IVT 组 125 例。匹配后分析 250 例患者，两组 sICH 无显著差异。然而，IVT 组 90 天 mRS（0-2）评分（70.4%比 57.6%；p=0.048）优于非-IVT 组。
结论
IVT 改善了 AIS 合并 CKD 患者 3 个月的预后，且不会增加 sICH 的发生。
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