摘要目的 对比穿支动脉区孤立性梗死与其他类型脑梗死经静脉rtPA溶栓治疗后出血转化及神经功能结局的差异,明确穿支动脉区孤立性梗死静脉溶栓的安全性和有效性.方法 回顾分析了浙江大学医学院附属第二医院神经内科前瞻性收集的2009.06-2011.04期间接受静脉rtPA溶栓治疗的缺血性中风患者资料,包括性别、年龄、既往史、溶栓时间、基线NIHSS、血压、血糖、电解质、凝血谱、心电图、头颅MRI、颅内外MRA(或CTA)等,按照中国缺血性中风亚型(CISS)标准1予以病因分组.结果 共75例患者接受静脉rtPA治疗,年龄(67.4±12.7)岁,女性25例,占33.3％；溶栓前NIHSS(12.3±6.4)分；发病至溶栓时间:(239.6±97.5)min; 72例(96％)在24 h接受多模式MRI复查.共24例(32％)示溶栓后出血转化,4例(5.3％)为症状性出血.22例(29.3％)患者为穿支动脉区域孤立性梗死,仅1例(1.3％)发生出血转化.Logistic回归分析发现,穿支动脉区孤立性梗死明显降低溶栓后的出血转化风险(OR=0.075,95％CI:0.008～0.663; P=0.020).并发现,82％的穿支动脉区孤立性梗死患者的1月mRS评分≤2,其神经功能结局较其梗死好(P＜0.01).结论 穿支动脉区域孤立梗死患者相对于其他类型脑梗死患者在经静脉rtPA溶栓治疗后,显示出更低的出血转化率和较好的神经功能结局,故对 此类患者的静脉溶栓治疗可更积极.

abstractsObjective To investigate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rtPA)in patients with isolated penetrating artery territory infarct (IPAI).Methods Data of retrospectively collected clinical,laboratory,and radiological from 75 consecutive patients with acute ischemic stroke treated with intravenous rtPA therapy from June 2009 to April 2011.Etiological classification was carried out according to the Chinese Ischemic Stroke Classification of Subgroups(CISS).The rates of hemorrhagic transformation(HT)and clinical outcomes of patients were compared between IPAI group and non-IPAI group.Results All 75 patients with mean age of 67.4years and 25(33.3％)fenale,were treated with intravenous rtPA.Before treatment,their average score of the National Institutes of Health Stroke Scale(NIHSS)was 12.3 ± 6.4,and mean length of time from onset to treatment was 239.6 ±97.5 minutes.After thrombolytic therapy,the radiological HT was found in 24 patients(32％).Symptomatic intracraneal hemorrhage(ICH)occurred in 4 patients(5.3％).Of 22 (29.3％)patients with IPAI,only one experienced HT.Logistic regression analysis suggested that IPAI wasan individualized predictor used alone for determining the low risk of HT.In the patients with IPAI,82％ of them had an individual clinical outcome(mRS ＜ 2)one month after onset,and the neurological outcomes were better in patients with IPAI than those in patients with non-IPAI(P ＜ 0.01).Conclusions The risk of hemorrhagic complication was low and the clinical outcome was good in patients with isolated penetrating artery territory infarct after intravenous thrombolytic therapy with rtPA.Imaging diagnosis of IPAI might facilitate the treatment with rtPA in this cohort of patients.