中国全科医学2025，Vol.28Issue(20)：2508-2515,8.DOI:10.12114/j.issn.1007-9572.2024.0442
磁共振成像指导急性缺血性脑卒中静脉溶栓治疗效果的真实世界研究
A Real-world Study of MRI-guided Intravenous Thrombolytic Therapy in Acute Ischemic Stroke
摘要
Abstract
Background Ischemic stroke has a high rate of disability and mortality,and for some patients,the onset time is difficult to confirm,making treatment for these patients particularly important.Objective To explore the efficacy and safety of intravenous thrombolysis in patients with acute ischemic stroke of unknown onset time,guided by the mismatch between diffusion-weighted imaging(DWI)and fluid-attenuated inversion recovery(FLAIR)on MRI,in primary hospitals lacking CT perfusion.Methods A retrospective analysis was performed on 460 patients with acute ischemic stroke treated in the First People's Hospital of Lin'an District,Hangzhou,from March 2020 to February 2024.Patients with acute ischemic stroke and unknown onset time,excluding large vessel occlusion,were selected if their last known normal time was>4.5 hours and the time from symptom onset to treatment initiation was<4.5 hours.Those with DWI/FLAIR mismatch on MRI who received intravenous thrombolysis were included in the thrombolysis group.The control group consisted of acute ischemic stroke patients,within a clear time window of 4.5 hours or with an unknown onset time had DWI/FLAIR mismatch present and were eligible for intravenous thrombolysis,but refused the treatment.Clinical outcome measures were collected,including early neurological improvement,NIHSS score at 24 hours,hemorrhagic transformation,symptomatic intracranial hemorrhage(sICH),90-day Modified Rankin Scale(mRS)score,90-day mortality,and recorded occurrences of alteplase allergic reactions and ICU admissions.The efficacy and safety of treatment between the two groups were compared.Univariate analysis and multivariable binary Logistic regression models were used to analyze the influencing factors of early neurological improvement.Results A total of 83 patients were included in the thrombolysis group,51(61.4%)were male,with a mean age of(70.1±12.4)years.The control group had 55 patients,with 32(58.2%)male and a mean age of(70.6±13.4)years.The thrombolysis group had a higher baseline NIHSS score and longer symptom recognition-to-admission time than the control group(P<0.05).The early neurological improvement rate in the thrombolysis group[50.6%(42/83)]was significantly higher than that in the control group[23.6%(13/55)](P<0.05).There were no significant differences between the two groups in NIHSS score at 24 hours,hemorrhagic transformation rate,or symptomatic intracranial hemorrhage rate(P>0.05).When comparing males and females in terms of early neurological improvement,no significant differences were found[thrombolysis group:males 26(61.9%),females 16(38.1%),χ2=0.008,P>0.05;control group:males 6(46.2%),females 7(53.8%),χ2=1.012,P>0.05].Multivariate Logistic regression analysis showed that intravenous thrombolysis was an influencing factor for early neurological improvement(OR=2.891,95%CI=1.319-6.337,P=0.008).After adjusting for variables,the result indicated that pre-hospital notification combined with intravenous thrombolysis was an influencing factor for early neurological improvement(OR=6.938,95%CI=3.120-15.427,P<0.001).Conclusion In case of mild to moderate ischemic stroke without large vessel occusion,primary stroke centers using MRI to guide intravenous thrombolysis can provide short-term benefits for ischemic stroke patients with unknown onset time.Additionally,implementing pre-hospital notification may be more beneficial for early neurological recovery in these patients.关键词
卒中/醒后卒中/不明发病时间卒中/静脉溶栓/院前通知/磁共振成像/观察性研究Key words
Stroke/Wake-up stroke/Unknown onset time stroke/Intraveous thrombolytic/Pre-hospital notification/Magnetic resonance imaging/Observational study分类
临床医学引用本文复制引用
谈毅,祝丽红,尹增维,侯舒喃,俞厚明..磁共振成像指导急性缺血性脑卒中静脉溶栓治疗效果的真实世界研究[J].中国全科医学,2025,28(20):2508-2515,8.基金项目
杭州市卫生科技计划(B20230334) （B20230334）
