挪威替奈普酶溶栓治疗试验（NOR-TEST）中青年脑卒中患者中脑卒中模拟的特征及预测因素。
Characteristics and predictors of stroke mimics in young patients in the norwegian tenecteplase stroke trial (NOR-TEST).
机构信息
Norwegian University of Science and Technology, Trondheim (NTNU), Trondheim, 7034, Norway.
Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway.
出版信息
BMC Neurol. 2023 Nov 15;23(1):406. doi: 10.1186/s12883-023-03425-x.
BACKGROUND
Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group.
METHODS
Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with acute ischemic stroke. Patients diagnosed with either acute cerebral ischemia or transient ischemic attack were categorized as stroke group, and patients with any diagnosis other than ischemic stroke or transient ischemic attack as mimics group. Patients were grouped post-hoc into young (< 60 years) and old (≥ 60 years). Logistic regression analyses were performed with mimics vs. stroke as dependent variable to identify predictors of mimics.
RESULTS
Of the 1091 patients included in the trial, 211 patients (19.3%) were under the age of 60 years. Out of the 1091 patients, 434 (39.8%) were female, median age 77 years (18-99 years), and median NIHSS was 4. Sixty-nine patients (32.7%) out of the 211 patients under the age of 60 were diagnosed as mimic. Mimics were significantly more frequent among the young (OR = 3.3, 32.7% vs. 12.8%, p = < 0.001). The most frequent mimics diagnoses among patients under 60 years of age were migraine (11.8%), no definite diagnosis (11.4%) and peripheral vertigo (3.3%). Mimics were independently associated with age < 50 years (OR = 4.97, p = < 0.001), not currently working/studying (OR = 3.38, p = 0.002) and not having aphasia on admission (OR = 2.95, p = 0.025). None of the mimics under the age of 60 years had symptomatic or asymptomatic intracerebral hemorrhage as a complication to thrombolysis.
CONCLUSION
We found significantly more mimics in the young, of which migraine was the most predominant diagnosis. Thrombolysis with alteplase or tenecteplase did not cause ICH in any mimics under 60 years.
背景
多项研究表明，年轻患者中风模拟的发生率更高。我们的目的是确定接受溶栓治疗的 60 岁以下年轻患者中常见的模拟情况，分析溶栓治疗后出血的风险，并确定可能识别该组模拟情况的风险因素和临床参数。
方法
挪威替奈普酶溶栓治疗试验是一项 3 期试验，旨在研究替奈普酶与阿替普酶治疗急性缺血性脑卒中的安全性和疗效。诊断为急性脑缺血或短暂性脑缺血发作的患者被归类为卒中组，诊断为缺血性卒中和短暂性脑缺血发作以外的任何诊断的患者被归类为模拟组。根据患者年龄分为年轻（<60 岁）和年老（≥60 岁）组。采用逻辑回归分析以模拟为因变量，确定模拟的预测因素。
结果
在 1091 例患者中，211 例（19.3%）年龄<60 岁。1091 例患者中，434 例（39.8%）为女性，中位年龄为 77 岁（18-99 岁），NIHSS 中位数为 4 分。211 例<60 岁患者中，69 例（32.7%）被诊断为模拟。年轻患者中模拟的发生率明显更高（OR=3.3，32.7%比 12.8%，p<0.001）。<60 岁患者中最常见的模拟诊断为偏头痛（11.8%）、无明确诊断（11.4%）和周围性眩晕（3.3%）。模拟与年龄<50 岁（OR=4.97，p<0.001）、未工作/学习（OR=3.38，p=0.002）和入院时无失语症（OR=2.95，p=0.025）独立相关。<60 岁的模拟患者无一例因溶栓治疗出现症状性或无症状性颅内出血的并发症。
结论
我们发现年轻患者中模拟的发生率明显更高，其中偏头痛是最主要的诊断。阿替普酶或替奈普酶溶栓治疗未导致任何<60 岁模拟患者发生 ICH。
Zotero 插件