CAJ | 학술논문

目的探讨磁共振成像(MRI)快速评价指导的觉醒型缺血性卒中(wake-up ischemic strokes,WUIS)患者静脉溶栓治疗的应用价值.方法通过对WUIS患者和发病12 h内卒中患者行CT平扫初筛后排除颅内出血,行MR快速成像序列检查,筛选符合超急性期缺血性卒中患者,即DWI呈高信号,而T2WI或液体衰减反转恢复序列(FLAIR)无高信号改变及T1WI无低信号改变者,行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,对WUIS患者组和发病12 h卒中患者组进行临床、影像对照研究及90 d改良Rankin评分(modified Rankin scale,mRS)和生活质量Barthal指数(Barthal index,BI)比较.结果 463例被纳入本研究并进行MRI快速评价,其中261例(261/463,56.4％)通过MRI界定为超急性期缺血性卒中(WUIS组73例,73/121 =60.3％;12 h组188例,188/342=55.0％).192例(WUIS组53例和12 h组139例)进行溶栓治疗,两组基线资料及溶栓后出血转化和病死率差异无统计学意义(P均＞0.05),90 d mRS评分及生活质量BI差异无统计学意义(x2=1.296、1.473,P=0.538、0.489).结论对MRI快速评价指导的WUIS患者行静脉溶栓治疗是一种安全、有效的治疗方法.
목적 탐토자공진성상(MRI)쾌속평개지도적각성형결혈성졸중(wake-up ischemic strokes,WUIS)환자정맥용전치료적응용개치.방법 통과대WUIS환자화발병12 h내졸중환자행CT평소초사후배제로내출혈,행MR쾌속성상서렬검사,사선부합초급성기결혈성졸중환자,즉DWI정고신호,이T2WI혹액체쇠감반전회복서렬(FLAIR)무고신호개변급T1WI무저신호개변자,행중조조직형섬용매원격활제(rt-PA)정맥용전치료,대WUIS환자조화발병12 h졸중환자조진행림상、영상대조연구급90 d개량Rankin평분(modified Rankin scale,mRS)화생활질량Barthal지수(Barthal index,BI)비교.결과 463례피납입본연구병진행MRI쾌속평개,기중261례(261/463,56.4％)통과MRI계정위초급성기결혈성졸중(WUIS조73례,73/121 =60.3％;12 h조188례,188/342=55.0％).192례(WUIS조53례화12 h조139례)진행용전치료,량조기선자료급용전후출혈전화화병사솔차이무통계학의의(P균＞0.05),90 d mRS평분급생활질량BI차이무통계학의의(x2=1.296、1.473,P=0.538、0.489).결론 대MRI쾌속평개지도적WUIS환자행정맥용전치료시일충안전、유효적치료방법.
Objective To investigate the value of magnetic resonance imaging (MRI)-based intravenous thrombolysis in patients with wake-up ischemic strokes (WUIS).Methods Patients presenting within 12 hours of acute stroke symptom onset and those with WUIS confirmed by CT,excluding intracranial hemorrhage,were encouraged to perform an emergent brain MRI scan to confirm the diagnosis of hyperacute ischemic stroke (hyper-intense in DWI without hyper-intense change in T2WI or fluid attenuated inversion recovery (FLAIR)).These patients then received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).All patients were divided into either stroke presenting within 12 hours or WUIS.The clinical outcomes were assessed by the modified Rankin scale (mRS) and the Barthal index (BI) at baseline and at 90 days after the thrombolysis therapy.Results Two hundred and sixty-one patients (261/563,56.4％) had confirmed diagnosis of hyperacute ischemic stroke (WUIS,n =73,73/121 =60.3％ vs within 12 hours,n =188,188/342 =55.0％).Altogether,192 patients (139 in within 12 hours group,and 53 in WUIS group) received intravenous thrombolytic therapy with rt-PA.No significant differences were found between the 2 groups at the baseline characteristics and at 90 days outcomes after the thrombolysis therapy(x2 =1.296 and 1.473,P =0.538 and 0.489,respectively).Also no significant differences were found in the incidence rate of secondary hemorrhage (including both of asymptomatic and symptomatic) and mortality rate between the 2 groups.Conclusion MRI-based intravenous thrombolysis is safe and effective in the treatment of patients with hyperacute WUIS.