轻型缺血性卒中TOAST分型及静脉溶栓的研究

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摘要目的评测轻型缺血性卒中TOAST各亚型rt-PA静脉溶栓治疗的安全性和短期预后。方法选取承德市中心医院2013年11月~2016年1月收治的256例轻型缺血性卒中患者，其中136例接受rt-PA静脉溶栓（静脉溶栓组），120例接受口服药物治疗（未溶栓组），并对两组患者进行TOAST病因分型。治疗90 d后评测NIHSS评分、改良Rankin量表评分（mRS），其中NIHSS评分0~1分、mRS为0~1分者定义为良好结局，并比较两组患者90 d内脑出血率、死亡率和复发率。结果静脉溶栓组患者良好结局的比例明显高于未溶栓组（P ＜ 0.05），复发率明显低于未溶栓组（P ＜ 0.05）。其中，大动脉粥样硬化型（LAA）亚组患者接受静脉溶栓良好结局的比例明显高于未溶栓者（P ＜ 0.05），其脑梗死复发率明显降低（P ＜ 0.05）。结论 rt-PA静脉溶栓治疗可提高轻型缺血性卒中，尤其是LAA型患者90 d内良好结局的比例，减少复发率，安全性可。

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	朱海暴杨静沈永玲齐丽敏冯丽张冠文桑晓一程瑞年

关键词 ：轻型缺血性卒中, 重组组织型纤溶酶原激活剂, 溶栓治疗, TOAST分型

Abstract：Objective To analysis safety and short-term prognosis of rt-PA intravenous thrombolysis treatment in different TOAST subtype of minor ischaemic stroke. Methods From November 2013 to January 2016, 256 patients with mild ischaemic stroke in Chengde Central Hospital were selected. 136 patients were treated with rt-PA intravenous thrombolysis (intravenous thrombolysis group), and 120 patients were treated with oral drugs (non thrombolysis group), the patients in the two groups were divided by TOAST etiology. 90 days after treatment, the scores of NIHSS and mRS, the cerebral hemorrhage rate, death rate, recurrence rate were observed, besides the NIHSS score of 0-1 and mRS of 0-1 were defined as good outcomes. Results The proportion of good outcomes in the intravenous thrombolysis group was higher than that of the non thrombolysis group, the recurrence rate was lower than that of the non thrombolysis group, with statistically significant difference (P < 0.05). And the proportion of good outcomes in the LAA subgroup who were treated with rt-PA intravenous thrombolysis was higher and the recurrence rate was lower (P < 0.05). Conclusion rt-PA intravenous thrombolysis can improve the proportion of good outcomes in the patients with minor ischaemic stroke in 90 days, especially LAA subtype, reduce the recurrence rate, and it has good safety.

Key words： Minor ischaemic stroke Recombinant tissue plasminogen activator Thrombolytic therapy TOAST etiology

基金资助:河北省承德市科学技术研究与发展计划资助项目（201422001）。

作者简介: 朱海暴（1976.1-），男，硕士，副主任医师，硕士研究生导师；研究方向：脑血管病基础与临床。

引用本文:

朱海暴杨静沈永玲齐丽敏冯丽张冠文桑晓一程瑞年. 轻型缺血性卒中TOAST分型及静脉溶栓的研究[J]. 中国医药导报, 2017, 14(23): 56-59.
ZHU Haibao YANG Jing SHEN Yongling QI Limin FENG Li ZHANG Guanwen SANG Xiaoyi CHENG Ruinian. The study of intravenous thrombolysis for different TOAST subtype of minor ischaemic stroke. 中国医药导报, 2017, 14(23): 56-59.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I23/56

[1] Barber PA，Zhang J，Demchuk AM，et al. Why are stroke?鄄patients excluded from TPA therapy？An analysis of patient eligibility [J]. Neurology，2001，56（8）：1015-1020.
[2] 姬海超，闫福岭.轻型脑梗死的溶栓治疗[J].中华脑血管病杂志，2012，6（5）：239-245.
[3] Yeo LL，Ho R，Paliwal P，et al. Intravenously administered tissue plasminogen activator useful in milder strokes？A meta-analysis [J]. J Stroke Cerebrovasc Dis，2014，23（8）：2156-2162.
[4] Greisenegger S，Seyfang L，Kiechl S，et al. Thrombolysis in patients with mild stroke：results from the Austrian Stroke Unit Registry [J]. Stroke，2014，45（3）：765-769.
[5] Logallo N，Kvistad CE，Naess H，et al. Mild stroke：safety and outcome in patients receiving thrombolysis [J]. Acta Neurol Scand Suppl，2014，129（198）：37-40.
[6] Huisa BN，Raman R，Neil W，et al. Intravenous tissue plasminogen activator for patients with minor ischemic stroke [J]. J Stroke Cerebrovasc Dis，2012，21（8）：732-736.
[7] Frank B，Grotta JC，Alexandrov AV，et al. Thrombolysis in stroke despite contraindications or warnings？[J] Stroke，2013，44（3）：727-733.
[8] Sandercock P，Wardlaw JM，Lindley RI，et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke （the third international stroke trial [IST-3]）：a ran?鄄domised controlled trial [J]. Lancet，2012，379（9834）：2352-2363.
[9] Adams HP Jr，Bendixen BH，Kappelle LJ，et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment [J]. Stroke，1993，24（1）：35-41.
[10] Hacke W，Kaste M，Bluhmki E，et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke [J]. N Engl J Med，2008，359（13）：1317-1329.
[11] National Institute of Neurological Disorders Stroke rt-PASS Stroke Study Group. Recombinant tissue plasminogen activator for minor strokes：the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study experience [J]. Ann Emerg Med，2005，46（2）：243-252.
[12] Fischer U，Baumgartner A，Arnold M，et al. What is a minor stroke？[J]. Stroke，2010，41（4）：661-666.
[13] Reeves M， Khoury J， Alwell K， et al. Distribution of National Institutes of Health stroke scale in the Cincinnati/Northern Kentucky Stroke Study[J]. Stroke. 2013， 44（11）：3211-3213.
[14] Smith EE，Fonarow GC， Reeves MJ，et al. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator：findings from get with the guidelines-stroke [J]. Stroke，2011，42（11）：3110-3115.
[15] Khatri P，Conaway MR，Johnston KC. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke [J]. Stroke，2012，43（2）：560-562.
[16] Nedeltchev K，Schwegler B，Haefeli T，et al. Outcome of stroke with mild or rapidly improving symptoms [J]. Stroke，2007，38（9）：2531-2535.
[17] Choi JC，Jang MU，Kang K，et al. Comparative effectiveness of standard care with Ⅳthrombolysis versus without Ⅳ thrombolysis for mild ischemic stroke [J]. J Am Heart Assoc，2015，4（1）：e001306.
[18] Khatri P，Kleindorfer DO，Yeatts SD，et al. Strokes with minor symptoms：an exploratory analysis of the National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trials [J]. Stroke，2010，41（11）：2581-2586.
[19] Hassan AE，Zacharatos H，Hassanzadeh B，et al. Does mild deficit for patients with stroke justify the use of intravenous tissue plasminogen activator？[J]. J Stroke Cerebrovasc Dis，2010，19（2）：116-120.