Yang Kiyoon, Kim Kyung Hwan, Jeong Heewon, Jeong Eun-Oh, Lee Han-Joo, Kwon Hyon-Jo, Choi Seung-Won, Kim Seon-Hwan, Koh Hyeon-Song
Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
Neurosurg Rev. 2025 May 30;48(1):468. doi: 10.1007/s10143-025-03615-w.
Spontaneous intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) is associated with high mortality and severe disability. This study aimed to compare the effects of urokinase-type plasminogen activator (uPA) and recombinant tissue-type plasminogen activator (r-tPA) on functional outcomes and IVH clearance in patients with IVH.
A retrospective analysis was conducted on 97 patients with IVH treated from January 2014 to February 2024. Patients received either uPA or r-tPA via external ventricular drainage (EVD) and were assessed using the modified Rankin Scale (mRS) at 180 days. Prognostic factors were analyzed to evaluate the treatment effects.
The 180-day mRS outcomes were similar between the uPA and r-tPA groups (P = 0.817). However, r-tPA achieved faster IVH clearance (P = 0.022) with shorter dosing and drain durations. By postoperative day 3, the IVH volume significantly decreased in the r-tPA group, allowing earlier intraventricular fibrinolysis cessation. ICU stays were shorter and infection rates lower in the r-tPA group, but these differences were not statistically significant. Multivariate analysis identified the NIHSS and initial ICH volume as key outcome predictors (P = 0.048, P = 0.035).
While r-tPA facilitated faster IVH clearance, it did not improve long-term functional outcomes. Faster clearance with r-tPA may help reduce ICU stays and infection rates, but initial neurological status remains a primary prognostic factor. Larger studies are needed to confirm these findings and evaluate the potential benefits of r-tPA in IVH management.
自发性脑出血（ICH）合并脑室出血（IVH）与高死亡率和严重残疾相关。本研究旨在比较尿激酶型纤溶酶原激活剂（uPA）和重组组织型纤溶酶原激活剂（r-tPA）对IVH患者功能结局和IVH清除率的影响。
对2014年1月至2024年2月治疗的97例IVH患者进行回顾性分析。患者通过外部脑室引流（EVD）接受uPA或r-tPA治疗，并在180天时使用改良Rankin量表（mRS）进行评估。分析预后因素以评估治疗效果。
uPA组和r-tPA组180天的mRS结局相似（P = 0.817）。然而，r-tPA实现了更快的IVH清除（P = 0.022），给药和引流时间更短。到术后第3天，r-tPA组的IVH体积显著减少，允许更早停止脑室内纤溶治疗。r-tPA组的重症监护病房住院时间更短，感染率更低，但这些差异无统计学意义。多变量分析确定美国国立卫生研究院卒中量表（NIHSS）和初始ICH体积是关键结局预测因素（P = 0.048，P = 0.035）。
虽然r-tPA促进了更快的IVH清除，但并未改善长期功能结局。r-tPA更快的清除可能有助于减少重症监护病房住院时间和感染率，但初始神经状态仍然是主要的预后因素。需要更大规模的研究来证实这些发现，并评估r-tPA在IVH管理中的潜在益处。
