von Kummer R, Bluhmki E, Ringleb P, Hacke W
Abteilung Neuroradiologie, Universitätsklinikum Carl Gustav Carus, TU Dresden.
Nervenarzt. 1998 Aug;69(8):678-82. doi: 10.1007/s001150050328.
Following the study protocol, we stratified the 615 patients of ECASS I according age (< or =/-70 years) and analysed the response to intravenous rt-PA in both subgroups. The older patients (248) suffered from the same stroke severity as the younger patients (367) experienced, however, a more severy clinical course (placebo group after 3 months after stroke: Barthel Index 50 vs. 85, mortality 24% vs. 11%). Treatment with rt-PA increased the proportion of undisabled patients at 3 months after stroke onset significantly only in the younger patients. The risk for brain parenchymal hemorrhage was increased by the factor of 4.7 and 4.6 in both age groups. It is obviously harder to achieve an undisabled state by systemic thrombolysis in the elderly. Facing the risk of brain hemorrhage associated with rt-PA, the risk-benefit-ratio may be less favourable in patients over 70 years.
按照研究方案，我们根据年龄（≤70岁或＞70岁）对ECASS I研究中的615例患者进行分层，并分析了两个亚组对静脉注射rt-PA的反应。老年患者（248例）与年轻患者（367例）的中风严重程度相同，然而，临床病程更严重（中风后3个月时，安慰剂组：巴氏指数分别为50和85，死亡率分别为24%和11%）。rt-PA治疗仅在年轻患者中显著增加了中风发作后3个月时未致残患者的比例。两个年龄组脑实质出血的风险分别增加了4.7倍和4.6倍。显然，老年人通过全身溶栓达到非残疾状态更难。面对与rt-PA相关的脑出血风险，70岁以上患者的风险效益比可能不太有利。
