CAJ | 학술논문

目的通过分析华山医院接受静脉溶栓治疗的急性缺血性卒中患者的预后,探讨静脉溶栓治疗良好结局的相关预测因素.方法回顾性分析2008年1月至2013年5月华山医院所有接受静脉溶栓治疗的急性缺血性卒中患者的临床资料.按3个月临床结局改良Rankin量表评分将患者分为结局良好组(＜2分)及结局不良组(≥2分),进行单因素及多因素相关分析.结果连续纳入148例急性缺血性卒中患者,在4.5h时间窗内溶栓患者的结局良好比例为52.4％ (65/124),明显优于超时间窗的患者的20.8％ (5/24;x2=8.048,P=0.005).单因素分析显示:患者年龄(U=2 146.000,P=0.025)TOAST分型(x2=11.412,P=0.010)、牛津郡社区卒中项目(OCSP)分型(x2=17.409,P=0.001)、基线血糖(U=1 446.500,P＜0.01)、基线纤维蛋白原(U=1689.000,P=0.038)、入院时美国国立卫生研究院卒中量表(NIHSS)评分(U=1 140.000,P＜0.01)、24 h NIHSS评分(U=458.000,P＜0.01)及早期症状改善(24 h NIHSS评分降低≥4分或者降至0分;x2=19.576,P＜0.01)是影响临床结局的因素.多因素回归分析提示的独立预测因素有:年龄(OR=0.943,95％ CI 0.892 ～0.996,P=0.024)、基线纤维蛋白原(OR=0.448,95％ CI 0.208～0.963,P=0.040)、基线NIHSS评分(OR=0.749,95％ CI 0.663 ～ 0.845,P＜0.01)和早期症状改善(OR=14.970,95％ CI 4.460～50.249,P＜0.01).结论静脉溶栓治疗的疗效有明确的时间依赖性.年龄、基线纤维蛋白原、基线NIHSS评分和早期症状改善为静脉溶栓3个月结局的独立预测因素.
목적 통과분석화산의원접수정맥용전치료적급성결혈성졸중환자적예후,탐토정맥용전치료량호결국적상관예측인소.방법 회고성분석2008년1월지2013년5월화산의원소유접수정맥용전치료적급성결혈성졸중환자적림상자료.안3개월림상결국개량Rankin량표평분장환자분위결국량호조(＜2분)급결국불량조(≥2분),진행단인소급다인소상관분석.결과 련속납입148례급성결혈성졸중환자,재4.5h시간창내용전환자적결국량호비례위52.4％ (65/124),명현우우초시간창적환자적20.8％ (5/24;x2=8.048,P=0.005).단인소분석현시:환자년령(U=2 146.000,P=0.025)TOAST분형(x2=11.412,P=0.010)、우진군사구졸중항목(OCSP)분형(x2=17.409,P=0.001)、기선혈당(U=1 446.500,P＜0.01)、기선섬유단백원(U=1689.000,P=0.038)、입원시미국국립위생연구원졸중량표(NIHSS)평분(U=1 140.000,P＜0.01)、24 h NIHSS평분(U=458.000,P＜0.01)급조기증상개선(24 h NIHSS평분강저≥4분혹자강지0분;x2=19.576,P＜0.01)시영향림상결국적인소.다인소회귀분석제시적독립예측인소유:년령(OR=0.943,95％ CI 0.892 ～0.996,P=0.024)、기선섬유단백원(OR=0.448,95％ CI 0.208～0.963,P=0.040)、기선NIHSS평분(OR=0.749,95％ CI 0.663 ～ 0.845,P＜0.01)화조기증상개선(OR=14.970,95％ CI 4.460～50.249,P＜0.01).결론 정맥용전치료적료효유명학적시간의뢰성.년령、기선섬유단백원、기선NIHSS평분화조기증상개선위정맥용전3개월결국적독립예측인소.
Objective To determine factors associated with favorable clinical outcome in acute ischemic stroke patients who received intravenous thrombolysis.Methods Patients treated with intravenous recombinant tissue plasminogen activator (rt-PA) between January 1,2008 and May 31,2013 were recruited.Favorable outcome was defined as modified Rankin scale (mRS) score ＜ 2 at 3 months.The baseline characteristics were compared by univariate and multivariate analysis.Results Of all the 148 patients studied,within the 4.5-hour time window,the rate of patients with a favorable outcome was 52.4％ (65/124),significantly better than those beyond the time window(20.8％ (5/24),x2 =8.048,P =0.005).Univariate analysis showed that age (U =2 146.000,P =0.025),TOAST classification (x2 =11.412,P =0.010),Oxfordshire Community Stroke Project (OCSP) classification (x2 =17.409,P =0.001),baseline blood glucose (U =1 446.500,P ＜ 0.01),baseline fibrinogen (U =1 689.000,P =0.038),admission NIHSS score (U =1 140.000,P ＜ 0.01),24-hour NIHSS score (U =458.000,P ＜0.01),and early symptom improvement (24-hour NIHSS score decreased ≥ 4 points,or down to 0 point;x2 =19.576,P ＜ 0.01) were the factors associated with clinical outcomes.Multivariate analysis revealed that age (odds ratio (OR) =0.943,95％ confidence interval (CI) 0.892-0.996,P =0.024),baseline fibrinogen (OR =0.448,95％ CI 0.208-0.963,P =0.040),baseline NIHSS score (OR =0.749,95％ CI 0.663-0.845,P ＜ 0.01),and early symptom improvement (OR =14.970,95％ CI 4.460-50.249,P ＜ 0.01) were independent predictors of clinical outcomes.Conclusions The effect of intravenous thrombolysis on clinical outcomes of acute ischemic stroke patients is time-dependent.Age,baseline NIHSS score,baseline fibrinogen level,and early symptom improvement are independent predictors of clinical outcomes after intravenous thrombolysis.