CAJ | 학술논문

目的：探讨青年轻型急性缺血性卒中静脉溶栓治疗转归的预测因素。方法回顾性纳入连续接受静脉溶栓治疗的青年(年龄18~45岁)轻型急性缺血性卒中患者。根据发病后90 d时改良Rankin 量表( modified Rankin Scale, mRS)评分分为转归不良组(≥2分)和转归良好组(0~1分),比较2组人口统计学和基线临床特征,采用多变量logistic回归分析确定青年轻型急性缺血性卒中静脉溶栓后转归不良的独立预测因素。结果共纳入57例接受静脉溶栓治疗的青年轻型急性缺血性卒中患者,其中转归良好41例(71．93%),转归不良16例(28．07%)。转归不良组与转归良好组间既往卒中或短暂性脑缺血发作(transient ischemic attack, TIA)史(25．00%对4．88%；P=0．046)、吸烟(56．25%对19．51%；P=0．010)、心房颤动(31．25%对7．32%；P=0．032)、糖尿病(62．50%对21．95%；χ2=8．515,P=0．004)、大动脉粥样硬化性卒中(68．75%对21．95%；χ2=11．067,P=0．001)以及发病前接受抗血小板治疗(6．25%对34．15%；P=0．044)的患者构成比以及年龄( Z=2．396,P=0．020)差异有统计学意义。多变量logistic回归分析显示,年龄[优势比(odds ratio, OR)2．64,95%可信区间(confidence interval, CI)1．28~5．36；P=0．038]、既往卒中或TIA史(OR 2．25,95% CI 1．22~4．31；P=0．042)、心房颤动(OR 5．12,95% CI 1．58~19．23；P=0．032)、大动脉粥样硬化性卒中(OR 5．89,95% CI 1．78~19．92；P=0．002)是青年轻型急性缺血性卒中静脉溶栓治疗后转归不良的独立危险因素。结论年龄、既往卒中或TIA史、心房颤动以及大动脉粥样硬化性卒中是青年轻型急性缺血性卒中静脉溶栓后90 d转归不良的独立预测因素。
목적：탐토청년경형급성결혈성졸중정맥용전치료전귀적예측인소。방법회고성납입련속접수정맥용전치료적청년(년령18~45세)경형급성결혈성졸중환자。근거발병후90 d시개량Rankin 량표( modified Rankin Scale, mRS)평분분위전귀불량조(≥2분)화전귀량호조(0~1분),비교2조인구통계학화기선림상특정,채용다변량logistic회귀분석학정청년경형급성결혈성졸중정맥용전후전귀불량적독립예측인소。결과공납입57례접수정맥용전치료적청년경형급성결혈성졸중환자,기중전귀량호41례(71．93%),전귀불량16례(28．07%)。전귀불량조여전귀량호조간기왕졸중혹단잠성뇌결혈발작(transient ischemic attack, TIA)사(25．00%대4．88%；P=0．046)、흡연(56．25%대19．51%；P=0．010)、심방전동(31．25%대7．32%；P=0．032)、당뇨병(62．50%대21．95%；χ2=8．515,P=0．004)、대동맥죽양경화성졸중(68．75%대21．95%；χ2=11．067,P=0．001)이급발병전접수항혈소판치료(6．25%대34．15%；P=0．044)적환자구성비이급년령( Z=2．396,P=0．020)차이유통계학의의。다변량logistic회귀분석현시,년령[우세비(odds ratio, OR)2．64,95%가신구간(confidence interval, CI)1．28~5．36；P=0．038]、기왕졸중혹TIA사(OR 2．25,95% CI 1．22~4．31；P=0．042)、심방전동(OR 5．12,95% CI 1．58~19．23；P=0．032)、대동맥죽양경화성졸중(OR 5．89,95% CI 1．78~19．92；P=0．002)시청년경형급성결혈성졸중정맥용전치료후전귀불량적독립위험인소。결론년령、기왕졸중혹TIA사、심방전동이급대동맥죽양경화성졸중시청년경형급성결혈성졸중정맥용전후90 d전귀불량적독립예측인소。
Objective To investigate the predictive factors of outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis. Methods Consecutive young patients with mild acute ischemic stroke ( age 18- 45 years ) treated with intravenous thrombolysis were enrol ed retrospectively. According to the modified Rankin Scale (mRS) score at day 90 after onset, they were divided into either a poor outcome group ( mRS ≥2 ) or a good outcome group ( mRS 0- 1 ). The demographic and baseline clinical characteristics were compared. Multivariate logistic regression analysis was used to identify the independent predictive factors of poor outcome in young patients with mild acute ischemic stroke treated with intravenous thrombolysis. Results A total of 57 young patients with acute mild ischemic stroke treated with intravenous thrombolysis were enrol ed, including 41 patients (71. 93%) had good outcome and 16 (28. 07%) had poor outcome. There were significant differences in the proportion of the patients with previous stroke or transient ischemic attack (TIA) (25. 00% vs. 4. 88%; P=0. 046), smoking (56. 25% vs. 19. 51%; P=0. 010 ), atrial fibril ation (31. 25% vs. 7. 32%; P=0. 032 ), diabetes (62. 50% vs. 21. 95%;χ2 =8. 515, P=0. 004), large artery atherosclerotic stroke (68. 75% vs. 21. 95%;χ2 =11. 067, P=0. 001 ), and receiving antiplatelet therapy before symptom onset (6. 25% vs. 34. 15%;P=0. 044) and the age (Z=2. 396, P=0. 020) between the poor outcome group and the good outcome group. Multivariate logistic regression analysis showed that the age (odds ratio [OR] 2. 64, 95% confidence interval [CI] 1. 28-5. 36;P=0. 038), history of previous stroke or TIA (OR 2. 25, 95% CI 1. 22-4. 31;P=0. 042), atrial fibril ation (OR 5. 12, 95% CI 1. 58-19. 23; P=0. 032), and large artery atherosclerotic stroke (OR 5. 89, 95% CI 1. 78-19. 92; P=0. 002) were the independent risk factors for poor outcome after mild acute ischemic stroke thrombolytic therapy. Conclusions Age, history of stroke or TIA, atrial fibril ation, and large artery atherosclerotic stroke were the predictive factors of poor outcome at day 90 in young patients with mild acute ischemic stroke treated with intravenous thrombolysis.