|
|
Risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction |
QIN Jinbiao,ZHU Min,LIU Gaofei,CHENG Yishun,and FENG Wei |
Department of Neurology, the General Hospital of the Eastern Theater Commands (Former Hospital 81of PLA), Nanjing 210002, China |
|
|
Abstract Objective To investigate the risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.Methods Patients with acute cerebral infarction were selected, who were treated with alteplase thrombolytic therapy within 4.5 h of the onset in our hospital between January 2014 and January 2019. These patients were divided into the early neurological deterioration group and the non-deterioration group according to the occurrence of early neurological deterioration. Demographics, clinical data, and laboratory test indicators were compared between the two groups. The risks factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction were analyzed by using multivariate logistic regression analysis.Results A total of 108 patients with acute cerebral infarction were included in the study, 19 of whom were in the early neurological deterioration group. The age, body weight, proportion of atrial fibrillation, baseline NIHSS score, proportion of major vessel narrow or occlusion, white blood cell counts, and levels of fibrinogen in the early neurological deterioration group were significantly above those in the non-deterioration group. Multivariate logistic regression analysis showed that age(OR=3.285; 95%CI:2.023-5.682; P=0.028),body weight(OR=2.679; 95%CI:1.690-6.287; P=0.039), atrial fibrillation(OR=2.551; 95%CI:1.980-4.235; P=0.027), baseline NIHSS score(OR=3.627; 95%CI:6.267-13.331; P=0.018), and levels of fibrinogen(OR=2.016; 95%CI:4.650-7.823; P=0.031) were significantly correlated with early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.Conclusions The incidence of early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction is relatively high. Age, body weight, atrial fibrillation, baseline NIHSS scores, and levels of fibrinogen are risk factors for early neurological deterioration after intravenous thrombolysis in patients with acute cerebral infarction.
|
Received: 02 August 2019
|
|
|
|
|
[1] |
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.
|
[2] |
曹朝阳, 李 明, 朱新建, 等. 重组组织型纤溶酶原激活药静脉溶栓治疗发病4.5小时内急性脑梗死的疗效和安全性[J]. 武警医学, 2017, 28(7):653-655.
|
[3] |
Seners P, Turc G, Oppenheim C, et al. Incidence causes and predictors of neurological deterioration occurring within 24h following acute ischaemic stroke: a systematic review with pathophysiological implications[J]. J Neurol Neurosurg Ps, 2015, 86(1):87-94.
|
[4] |
Seet R C, Rabinstein A A. Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions [J]. Cerebrovasc Dis, 2012, 34(2):106-114.
|
[5] |
Siegler J E, Boehme A K, Kumar A D, et al. Identification of modifiable and nonmodifiable risk factors for neurologic deterioration after acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2013,22(7):E207-E213.
|
[6] |
中华医学会神经病学分会. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2014, 48(4): 246-258.
|
[7] |
Hill M D, Bucham A M. Thrombolysis for acute ischemic stroke: results of the Canadian alteplase for stroke effectiveness study [J]. CMAJ, 2015, 172(10):1307-1312.
|
[8] |
Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase 3-4.5 h after acute ischeamic stroke(SITS-ISTR):an observational study[J]. Lancet, 2008, 372(9646): 1303-1309.
|
[9] |
Tisserand M, Seners P, Turc G, et al. Mechanisms of unexplained neurological deterioration after intravenous thrombolysis[J]. Stroke, 2014, 45(12):3527-3534.
|
[10] |
Leigh R, Zaidat O O, Suri M F, et al. Predictors of hyperaute clinical worsening in ischemic stroke patients receiving thrombolytic therapy[J]. Stroke, 2004, 35(8):1903-1907.
|
[11] |
崔 颖,佟 旭,王伊龙,等. 急性缺血性卒中患者阿替普酶静脉溶栓后发生早期神经功能恶化的危险因素分析[J]. 中华神经科杂志, 2016,49(12):925-931.
|
[12] |
Siegler J E, Samai A, Semmes E, et al. Early neurological deterioration after stroke depends on vascular territory and stroke etiology [J]. J Stroke, 2016, 18(2): 203-210.
|
[13] |
Kim J M, Moon J, Ahn S W, et al. The etiologies of early neurological deteriroration after thrombolysis and risk factors of ischemia progression[J]. J Stroke Cerebrovasc Dis, 2016, 25(2):383-388.
|
[14] |
潘晓帆, 秦 琳, 韩 杨,等.阿替普酶溶栓治疗急性脑梗死早期神经功能恶化的相关危险因素分析[J].中风与神经疾病杂志, 2019, 26(2):140-143.
|
[15] |
Lou M, Selin M. Does body weight influence the response to intravenous tissue plasminogen activator in stroke patients[J]. Cerebrovasc Dis, 2009,27:84-90.
|
[16] |
Wang X G, Zhang L Q, Liao X L, et al. Unfavorable outcome of thrombolysis in Chinese patients with cardioembolic stroke: a prospective cohort study[J]. CNS Neurosci Ther, 2015, 21(8): 657-661.
|
[17] |
Sato Y, Ishibashi-Ueda H, Iwakiri T, et al. Thrombus components in cardioembolic and atherothronbotic stokes [J]. Thromb Res, 2012, 130(2): 278-280.
|
[18] |
Whiteley W N, Slot K B, Eernandes P, et al. Risk factors for intracranial hemorrhage in actue ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies [J]. Stroke, 2012, 43(11): 2904-2909.
|
[19] |
Strbian D, Meretoja A, Putaala J, et al. Cerebral edema in acute ischemic stroke patients treated with intravenous thrombolysis[J]. Int J Stroke, 2013, 8(7):529-534.
|
[20] |
董秋艳, 樊丽娟, 苏 慧, 等.急性缺血性脑卒中早期神经功能恶化的影响因素[J]. 武警医学, 2018, 29 (1): 21-24.
|
[21] |
Kyusik K, Kon C, Jae-Kyu R. POEMS syndrome, fibrinogen, and ischemic stroke: a critical point of view-reply[J]. Arch Neurol, 2004, 61(1):155-156.
|
|
|
|