急性缺血性脑卒中老年患者阿替普酶静脉溶栓的安全性及临床转归的影响因素。

Safety of alteplase intravenous thrombolysis and influencing factors of clinical outcome in elderly patients with acute ischemic stroke.

机构信息

Department of Neurology, Ruian People's Hospital, Wenzhou, Zhejiang, 325200, China.

Department of Pharmacy, Ruian People's Hospital, Wenzhou, Zhejiang, 325200, China.

出版信息

BMC Neurol. 2024 Nov 28;24(1):464. doi: 10.1186/s12883-024-03973-w.

DOI:10.1186/s12883-024-03973-w

PMID:39604864

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11603865/

Abstract

OBJECTIVE

To explore the safety of intravenous thrombolysis with alteplase (rt-PA) in the treatment of acute ischemic stroke (AIS) in the elderly (≥ 80 years old) and with analyze the influencing factors of its clinical outcome.

METHODS

A total of 144 elderly patients (≥ 80 years old) with AIS who were admitted to our hospital from April 2018 to October 2019 were divided into the elderly thrombolytic group (n = 55) and the elderly non-thrombolytic group (n = 89) according to their different treatment methods, and 166 non-elderly AIS thrombolytic patients in the same period were selected as the non-elderly thrombolytic group. Routine antiplatelet therapy or anticoagulant therapy was given to the elderly non-thrombolytic group, while intravenous thrombolysis with rt-PA was given to the elderly thrombolytic group and the non-elderly thrombolytic group. The changes in National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and intracranial hemorrhage transformation within 7 days, mortality within 3 months were used to evaluate the prognosis and safety of patients in each group. Binary Logistic regression was used to analyze the independent factors affecting the long-term prognosis of thrombolytic therapy for AIS in the elderly.

RESULTS

After the treatment, the short-term prognosis and the long-term prognosis improvement rates in the non-elderly thrombolytic group and the elderly thrombolytic group were higher than that in the elderly non-thrombolytic group (P < 0.05). There was no statistical difference in mortality between the elderly thrombolytic group and the elderly non-thrombolytic group or in intracranial hemorrhage transformation among the different groups (P > 0.05). Binary logistic regression analysis showed that NIHSS score before treatment was an independent risk factor affecting the long-term prognosis of elderly AIS patients after thrombolysis (P < 0.05).

CONCLUSION

Elderly AIS patients after rt-PA thrombolysis therapy can improve the short-term, long-term prognosis. The risk of intracranial hemorrhage transformation and death is not higher than that of elderly non thrombolytic patients, indicating that rt-PA treatment is safe for elderly AIS patients. The NIHSS score before treatment was an independent risk factor affecting the long-term prognosis of elderly AIS patients after thrombolytic therapy.

摘要

目的

探讨重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗高龄（≥80 岁）急性缺血性脑卒中（AIS）的安全性，并分析其临床转归的影响因素。

方法

选取我院 2018 年 4 月至 2019 年 10 月收治的 144 例高龄 AIS 患者（年龄≥80 岁），根据治疗方法不同分为高龄溶栓组（n=55）和高龄非溶栓组（n=89），同期选择 166 例非高龄 AIS 溶栓患者为非高龄溶栓组。高龄非溶栓组给予常规抗血小板或抗凝治疗，高龄溶栓组和非高龄溶栓组给予重组组织型纤溶酶原激活剂静脉溶栓治疗。采用美国国立卫生研究院卒中量表（NIHSS）、改良 Rankin 量表（mRS）和 7 天内颅内出血转化率评估各组患者预后及安全性，采用二元 Logistic 回归分析影响高龄 AIS 患者溶栓治疗长期预后的独立因素。

结果

治疗后，非高龄溶栓组和高龄溶栓组短期预后和长期预后改善率均高于高龄非溶栓组（P<0.05）；高龄溶栓组与高龄非溶栓组死亡率或各组间颅内出血转化率比较，差异均无统计学意义（P>0.05）。二元 Logistic 回归分析显示，治疗前 NIHSS 评分是影响高龄 AIS 患者溶栓后长期预后的独立危险因素（P<0.05）。