血液酒精浓度升高与急性缺血性卒中患者静脉溶栓治疗临床结局改善相关——一项回顾性研究
Elevated Blood Alcohol Concentration Is Associated with Improved Clinical Outcomes of Intravenous Thrombolysis Treatment in Acute Ischemic Stroke Patients-A Retrospective Study.
作者信息
Árokszállási Tamás, Balogh Eszter, Orbán-Kálmándi Rita, Pásztor Máté, Árokszállási Anita, Nagy Edit Boglárka, Belán Ivett, May Zsolt, Csépány Tünde, Csiba László, Bagoly Zsuzsa, Oláh László
机构信息
Department of Neurology, Faculty of Medicine, Doctoral School of Neuroscience, University of Debrecen, 22 Móricz Zsigmond krt, H-4032 Debrecen, Hungary.
Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt, H-4032 Debrecen, Hungary.
出版信息
J Clin Med. 2023 Mar 14;12(6):2238. doi: 10.3390/jcm12062238.
BACKGROUND
Intravenous thrombolysis (IVT) improves acute ischemic stroke (AIS) outcomes, but with limited success. In addition, ethanol potentiates the effect of r-tPA in ischemia models.
METHODS
The effect of acute alcohol consumption on IVT outcomes was investigated in a retrospective cohort study. AIS patients with detectable blood alcohol concentration (BAC) during IVT were included (alcohol group; = 60). For each case, 3 control subjects who underwent IVT but denied alcohol consumption were matched in terms of age, sex, affected brain area, and stroke severity. Outcomes were determined using the NIHSS at 7 days and the modified Rankin scale (mRS) at 90 days.
RESULTS
Patients were younger and had a less severe stroke than in a standard stroke study. Favorable long-term outcomes (mRS 0-2) occurred significantly more frequently in the alcohol group compared to controls (90% vs. 63%, < 0.001). However, the rates of hemorrhagic transformation were similar. Multiple logistic regression models identified elevated BAC as a significant protective factor against unfavorable short-term (OR: 0.091, 95% CI: 0.036-0.227, < 0.001) and long-term outcomes (OR: 0.187, 95% CI: 0.066-0.535, = 0.002). In patients with BAC > 0.2%, significantly lower NIHSS was observed at 3 and 7 days after IVT vs. in those with 0.01-0.2% ethanol levels.
CONCLUSION
Elevated BAC is associated with improved outcomes in IVT-treated AIS without affecting safety.
背景
静脉溶栓（IVT）可改善急性缺血性卒中（AIS）的预后，但成功率有限。此外，乙醇可增强r-tPA在缺血模型中的作用。
方法
在一项回顾性队列研究中，调查急性饮酒对IVT预后的影响。纳入在IVT期间可检测出血液酒精浓度（BAC）的AIS患者（酒精组；n = 60）。对于每例患者，匹配3名接受IVT但否认饮酒的对照者，在年龄、性别、患侧脑区和卒中严重程度方面进行匹配。使用7天时的美国国立卫生研究院卒中量表（NIHSS）和90天时的改良Rankin量表（mRS）确定预后。
结果
与标准卒中研究相比，患者年龄更小，卒中程度更轻。与对照组相比，酒精组中有利的长期预后（mRS 0 - 2）发生频率显著更高（90%对63%，P < 0.001）。然而，出血转化的发生率相似。多因素逻辑回归模型确定升高的BAC是预防不良短期（OR：0.091，95%CI：0.036 - 0.227，P < 0.001）和长期预后（OR：0.187，95%CI：0.066 - 0.535，P = 0.002）的显著保护因素。在BAC > 0.2%的患者中，与乙醇水平为0.01 - 0.2%的患者相比，IVT后3天和7天时观察到NIHSS显著更低。
结论
升高的BAC与IVT治疗的AIS预后改善相关，且不影响安全性。
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