Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator

医学 溶栓 改良兰金量表 内科学 组织纤溶酶原激活剂 冲程(发动机) 单变量分析 糖尿病 白质疏松症 纤溶剂 回顾性队列研究 外科 胃肠病学 缺血性中风 缺血 疾病 多元分析 心肌梗塞 机械工程 痴呆 工程类 内分泌学
作者
Yin-Hui Huang,Shitu Zhuo,Ya‐Fang Chen,Ming-mei LI,You‐Yu Lin,Meili Yang,Zhen-jie CHEN,Cai Ruowei
出处
期刊:Chinese Medical Journal [Lippincott Williams & Wilkins]
卷期号:126 (24): 4685-4690 被引量:18
标识
DOI:10.3760/cma.j.issn.0366-6999.20132354
摘要

Background Thrombolysis with recombinant tissue plasminogen activator (rt-PA) has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA. Methods One hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale (mRS) score, good outcome group: mRS score of 0-1; poor outcome group: mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression. Results Of the 101 patients studied, patients in good outcome group ( n =55) were significantly younger than patients in poor outcome group ( n =46, (62.82±14.25) vs. (68.81±9.85) years, P =0.029). Good outcome group had fewer patients with diabetic history (9.09% vs. 28.26%, P =0.012), fewer patients with leukoaraiosis (7.27% vs. 28.26%, P =0.005) and presented with lower blood glucose level ((5.72±1.76) vs. (6.72±1.32) mmol/L, P =0.012), lower systolic blood pressure level ((135.45±19.36) vs. (148.78±19.39) mmHg, P =0.003), lower baseline NIHSS score (12.02±5.26 vs. 15.78±4.98, P =0.002) and shorter onset-to-treatment time (OTT) ((2.38±1.21) vs. (2.57±1.03) hours, P =0.044) than poor outcome group. Logistic regression analysis showed that absence of diabetic history (odds ratio ( OR ) 0.968 (95% CI 0.941-0.996)), absence of leukoaraiosis ( OR 0.835 (95% CI 0.712-0.980)), lower baseline NIHSS score ( OR 0.885 (95% CI 0.793-0.989)), lower pre-thrombolysis systolic blood pressure ( OR 0.962 (95% CI 0.929-0.997)), and lower blood glucose level ( OR 0.699 (95% CI 0.491-0.994)) before thrombolysis were significantly associated with better outcome. Conclusion Patients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolysis have a better outcome.
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