Short-term clinical efficacy and prognosis of recombinant tissue plasminogen activator in anterior-posterior circulation acute ischemic stroke

doi:10.3969/j.issn.1004-583X.2021.05.007

Abstract

Abstract:

Objective To investigate the clinical effect and prognosis difference of recombinant tissue plasminogen activator (rt-PA) in intravenous thrombolysis for anterior-posterior circulation acute ischemic stroke(AIS). Methods The retrospective research was conducted in clinical data on 134 patients with anterior-posterior circulation AIS treated with rt-PA thrombolysis. According to infarction type, the patients were divided into anterior circulation group (ACI group, n=85), posterior circulation group (PCI group, n=49). NIHSS score and mRS score, early symptom improvement rate, good prognosis rate,symptomatic intracranial hemorrhage rate and mortality after thrombolysis were counted; and the clinical efficacy and safety of anterior-posterior circulation thrombolysis were assessed. Results After thrombolysis, NIHSS score and mRS score in PCI group were significantly lower than in ACI group (P<0.05). Conclusion Compared with anterior circulation infarction, the natural course of posterior circulation cerebral infarction is poor. And all patients can still benefit significantly if they were given rt-PA in time intravenous thrombolysis, and does not increase the bleeding risk.

Key words: brain infarction, fibrinolytic agents, anterior-posterior circulation

CLC Number:

R743.33

Wang Jun, Xiao Kejin, Gao Zhaoyu, Zhu Shenghua, Zhou Yi, Liu Xiaoyu, Cai Chaoqun. Short-term clinical efficacy and prognosis of recombinant tissue plasminogen activator in anterior-posterior circulation acute ischemic stroke[J]. Clinical Focus, 2021, 36(5): 421-424.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.05.007

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I5/421

Figures/Tables 4

References 18

[1]	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China clinical perspective: Results from a nationwide population-based survey of 480687 adults[J]. Circulation, 2017, 135(8):759. doi: 10.1161/CIRCULATIONAHA.116.025250 URL
[2]	殷文明, 张小宁. 重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性脑卒中疗效及安全性的Meta分析[J]. 中国全科医学, 2014, 17(14):1629-1634.
[3]	中国卒中学会科学声明专家组. 急性缺血性卒中静脉溶栓:中国卒中学会科学声明[J]. 实用心脑肺血管病杂志, 2017, 25(10):58.
[4]	宋红兵, 王琪. 静脉溶栓治疗前-后循环急性脑梗死的临床疗效比较[J]. 中国实用神经疾病杂志, 2016, 19(1):98-99.
[5]	Markus HS, van der Worp HB, Rothwell PM. Posterior circulation ischaemic stroke and transient ischaemic attack: Diagnosis, investigation, and secondary prevention[J]. Lancet Neurol, 2013, 12(10):989-998. doi: 10.1016/S1474-4422(13)70211-4 pmid: 24050733
[6]	张勇. 静脉溶栓治疗前循环急性脑梗死和后循环急性脑梗死的疗效分析[J]. 临床医药文献电子杂志, 2017, 4(98):19258-19259.
[7]	佟旭, 郑华光, 曹亦宾. 阿替普酶静脉溶栓治疗前、后循环卒中的安全性和有效性的meta分析[J]. 中风与神经疾病杂志, 2016, 33(9):802-807.
[8]	Nakagawara J, Minematsu K, Okada Y, et al. Thrombolysis with 0.6 mg/kg intravenous alteplase for acute ischemic stroke in routine clinical practice: The Japan post-marketing alteplase registration study (J-MARS)[J]. Stroke, 2010, 41(9):610-613.
[9]	张锦丽, 闫敏, 王璐琰. 不同剂量阿替普酶溶栓治疗急性脑梗死效果评价[J]. 解放军医药杂志, 2014, 26(11):79-81+88.
[10]	蔡超群, 许泽武, 高兆玉. 中等范围剂量阿替普酶静脉溶栓治疗急性期脑梗死的临床效果观察[J]. 临床合理用药杂志, 2020, 13(14):120-122.
[11]	重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组. 重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版)[J]. 中华内科杂志, 2012, 51(12):1006-1010.
[12]	Cates MJ, Paton JFR, Smeeton NC, et al. Hypertension before and after posterior circulation infarction: Analysis of data from the South London stroke register[J]. J Stroke Cerebrovasc Dis, 2012, 21(7):612-618. doi: 10.1016/j.jstrokecerebrovasdis.2011.02.004 URL
[13]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
[14]	谢江文, 吕国菊, 郑珍婕, 等. 不同年龄对阿替普酶静脉溶栓治疗急性脑梗死的临床疗效和预后的影响[J]. 中国临床药理学杂志, 2016, 32(6):486-488.
[15]	罗小春, 龚文健, 李敏辉. 不同时间窗重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的临床分析[J]. 中华全科医学, 2016, 14(5):763-765.
[16]	谭倩, 许康, 周瑞, 等. 重组组织型纤溶酶原激活剂静脉溶栓治疗急性缺血性脑卒中前后循环梗死疗效比较[J]. 疑难病杂志, 2011, 10(11):822-823.
[17]	李慧娟, 梁国良, 香瑞嫦, 等. 院前院内一体化模式联合急诊绿色通道对急性脑卒中患者救治时间及治疗效果的影响[J]. 名医, 2020, (11):156-157.
[18]	Liu L, Wang D, Wong KSL, et al. Stroke and stroke care in China: Huge burden, significant workload, and a national priority[J]. Stroke, 2011, 42(12):3651-3654. doi: 10.1161/STROKEAHA.111.635755 URL

组别	例数	男性 [例(%)]	年龄 (岁)	溶栓时间 (min)	心房颤动 [例(%)]	高血压 [例(%)]	糖尿病 [例(%)]	吸烟史 [例(%)]	脑卒中 [例(%)]
前循环组	85	42(49.41)	69.71±11.27	113.5±16.45	25(17.64)	73(85.88)	15(17.64)	22(25.88)	18(21.17)
后循环组	49	33(67.35)	66.65±10.01	136.68±15.97	5(10.20)	34(69.38)	23(46.93)	8(16.32)	14(28.57)
t/χ²值		4.057	1.571	8.247	6.600	5.256	13.127	1.633	0.935
P值		0.044	0.087	0.071	0.010	0.022	0.000	0.201	0.334

组别	例数	男性 [例(%)]	年龄 (岁)	溶栓时间 (min)	心房颤动 [例(%)]	高血压 [例(%)]	糖尿病 [例(%)]	吸烟史 [例(%)]	脑卒中 [例(%)]
前循环组	85	42(49.41)	69.71±11.27	113.5±16.45	25(17.64)	73(85.88)	15(17.64)	22(25.88)	18(21.17)
后循环组	49	33(67.35)	66.65±10.01	136.68±15.97	5(10.20)	34(69.38)	23(46.93)	8(16.32)	14(28.57)
t/χ²值		4.057	1.571	8.247	6.600	5.256	13.127	1.633	0.935
P值		0.044	0.087	0.071	0.010	0.022	0.000	0.201	0.334

组别	例数	NIHSS评分
组别	例数	治疗前	治疗后1 h	溶栓后3 h	溶栓24 h
前循环组	85	11.90±8.06	10.20±7.45^*	8.40±7.82^*	7.23±8.40^*
后循环组	49	8.79±8.08	5.73±7.36^*	5.65±7.36^*	4.10±6.46^*
组间		F=7.014 P=0.009
时点间		F=61.755 P=0.000
组间·时点间		F=0.084 P=0.773

组别	例数	NIHSS评分
组别	例数	治疗前	治疗后1 h	溶栓后3 h	溶栓24 h
前循环组	85	11.90±8.06	10.20±7.45^*	8.40±7.82^*	7.23±8.40^*
后循环组	49	8.79±8.08	5.73±7.36^*	5.65±7.36^*	4.10±6.46^*
组间		F=7.014 P=0.009
时点间		F=61.755 P=0.000
组间·时点间		F=0.084 P=0.773

组别	例数	mRS评分
组别	例数	治疗前	治疗后30 d	溶栓后90 d
前循环组	85	3.67±1.30	1.65±1.95^*	1.59±2.02^*
后循环组	49	3.06±1.33	1.08±2.01^*	1.02±2.03^*
组间		F=4.232 P=0.042
时点间		F=148.183 P=0.000
组间·时点间		F=0.016 P=0.984