MRI指导下轻中度脑梗死超时间窗静脉溶栓预后影响因素分析*

陈翠荣白青科赵振国隋海晶黄敬（1. 同济大学附属上海市第十人民医院神经内科 上海 0007；.上海市浦东新区人民医院神经内科上海 0199；.上海市浦东新区人民医院放射科 上海 0199）基金项目：上海市浦东新区青年科技项目(PW014B-19)

MRI指导下轻中度脑梗死超时间窗静脉溶栓预后影响因素分析*

陈翠荣1,2白青科2赵振国3隋海晶3黄敬1**
（1. 同济大学附属上海市第十人民医院神经内科 上海 200072；2.上海市浦东新区人民医院神经内科上海 201299；3.上海市浦东新区人民医院放射科 上海 201299）
*基金项目：上海市浦东新区青年科技项目(PW2014B-19)

摘 要目的：探讨影响轻、中度急性脑梗死超时间窗rt-PA静脉溶栓预后的危险因素。方法：收集发病4.5~12 h内轻、中度脑梗死（NIHSS评分≤15分）193例，MRI评价存在缺血半暗带47例，通过比较预后良好组和不良组之间的临床资料，分析影响预后的独立危险因素。结果：超时间窗溶栓47例病人中，多因素回归分析显示溶栓预后好与NIHSS评分低（OR 1.652，95%CI 1.391~3.814）、发病-给药时间短（OR 0.968，95%CI 0.841~0.998）、溶栓前基础血糖低（OR 2.010，95%CI 2.107~4.269）显著相关。NIHSS评分和发病-溶栓时间关系散点图揭示：超时间窗共47例病人中，预后良好38例，其中4.5~6 h占29例（76.32%），6~12 h占 9例且NIHSS评分≤7分；预后不良9例，其中有6例（66.67%）集中分布在6~12 h且NIHSS评分≥7分。结论：超时间窗患者溶栓前NIHSS评分低、血糖低、发病-溶栓时间短预后好，发病-溶栓时间越长，需要NIHSS较低，溶栓才可能获益。

关键词急性缺血性卒中 磁共振成像 血栓溶解疗法 预后 Logistic回归

The effect of MRI-based intravenous thrombolysis with recombinant tissue plasminogen activator on the prognosis of patients with mild-and-moderate
acute cerebral infarction and broadened therapeutic window*

CHEN Cuirong1,2, BAI Qingke2, ZHAO Zhenguo3, SUI Haijing3, HUANG Jing1**
(1. Department of Neurology, Shanghai Tenth People’s Hospital affiliated to Tongji University, Shanghai 200072, China; 2. Department of Neurology, the People’s Hospital of Pudong New District, Shanghai 201299, China; 3. Department of Radiology, the People’s Hospital of Pudong New District, Shanghai 201299, China)

ABSTRACTObjective: To investigate the risk factors of intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in the prognosis of patients with mild-and-moderate acute cerebral infarction and broadened therapeutic window. Methods: One hundred and ninety-three cases of patients were primarily screened, who were diagnosed as mild-and-moderate cerebral infarction (NIHSS score ≤15 points) within 4.5~12 hours of acute stroke symptom onset. Clinical data between good and poor prognosis were compared in 47 cases with ischemic penumbra confirmed by brain MRI scanning and the independent factors affecting prognosis were analyzed. Results: Logistic regression analysis showed that the good prognosis of thrombolysis was significantly related to the lower baseline NIHSS score (OR 1.652, 95%CI 1.391~3.814), shorter onset-to-treatment time (OR 0.968, 95%CI 0.841~0.998) and lower blood glucose level (OR 2.010, 95%CI 2.107~4.269). Scatter diagram for NIHSS score and onset - thrombolysis time indicated that there were 38 cases with good prognosis in 47 patients with broadened therapeutic window, in which there were 29 cases of patients (76.32%) with 4.5~12 hours and 9 cases of the patients with 6~12

hours and NIHSS scores≤7, and 9 patients with poor outcomes, in which there were 6 patients (66.67%) with 6~12 hours and NIHSS scores≥7. Conclusion: Patients with low baseline NIHSS score, lower blood glucose level, shorter onset-to-treatment time before thrombolysis treatment have a better outcome. Patients may have a better outcome if they have longer onset-totreatment time but enough lower baseline NIHSS score before thrombolysis treatment.

KEY WORDSacute ischemic stroke; magnetic resonance imaging; thrombolysis; prognosis; logistic regression analysis.

急性脑梗死具有高发病率、高致残率、高死亡率的特点，严重威胁着人类生命健康和生活质量。……