吴晓强 俞晓翔 谈正叶 金玉华 王琰萍

[摘要] 目的 分析静脉溶栓治疗中急性缺血性卒中TOAST分型特征及其预后。 方法 收集2019年1月至2020年3月我院卒中单元急性缺血性卒中静脉溶栓病例资料，利用NIHSS评分、改良Rankin量表评分（mRS）等量表评估方法，回顾性分析不同TOAST分型溶栓时神经功能缺损、溶栓后出血及病情反复等特征，探讨影响急性缺血性卒中3个月内预后因素。 结果 入组118例患者，不同TOAST亚型间溶栓前、后NIHSS评分比较，差异均有统计学意义（H=12.060，P<0.05;H=11.500，P<0.05）;72 h内各亚型溶栓后出血比较，差异有统计学意义（χ2=8.813，P<0.05）;各亚型24 h内病情反复比较，差异有统计学意义（χ2=8.123，P<0.05）;静脉溶栓3个月后评估，9个因素纳入模型，采用二元Logistic回归分析结果显示，年龄、性别及糖尿病病史不影响3个月内的预后。 结论 急性缺血性卒中静脉溶栓患者TOAST分型的各亚型在溶栓后出血和病情反复上存在差异;多种因素是急性缺血性卒中静脉溶栓3个月内预后的危险因素。

[关键词] 急性脑血管病;静脉溶栓;TOAST分型;预后

[中图分类号] R743.3          [文献标识码] A          [文章编号] 1673-9701（2021）34-0004-04

[Abstract] Objective To analyze the TOAST typing features of intravenous thrombolytic therapy on acute ischemic stroke （AIS） and its prognosis. Methods The data of intravenous thrombolysis cases of AIS in stroke unit of our hospital from January 2019 to March 2020 were collected， and the NIHSS score and modified Rankin scale score（mRS） were used to retrospectively analyze the features of nerve function defect， hemorrhage after thrombolysis and relapsed illness during thrombolysis in different TOAST typing， and the factors impacting the prognosis of AIS within 3 months were investigated. Results The NIHSS scores of 118 patients before and after thrombolysis among different TOAST subtypes were statistically significant（H=12.060， P<0.05; H=11.500，P<0.05）; There was statistically significant difference in hemorrhage among different subtypes within 72 hours （χ2=8.813，P<0.05）. There was significant difference between the subtypes within 24 hours （χ2=8.123，P<0.05）. Nine factors were included and evaluated in the model after 3 months of intravenous thrombolysis，and binary logistic regression analysis showed in the result that age，gender and diabetes history did not impact the prognosis within 3 months. Conclusion There are differences in hemorrhage and relapse after thrombolysis among different subtypes of TOAST typing in patients with AIS undergoing intravenous thrombolysis. Many factors are risk factors for prognosis of AIS after intravenous thrombolysis within 3 months.

[Key words] Acute cerebrovascular disease; Intravenous thrombolysis; TOAST typing; Prognosis

随着人口老年化日趋严重，急性缺血性卒中（Acute ischemic stroke，AIS）危害着人类健康。静脉溶栓仍是目前临床一线治疗方法，超早期应用组织型纤溶酶原激活物（Recombinant tissue plasminogen activator，rt-PA）静脉溶栓治疗是有效药物治疗手段之一[1]，然而，脑梗死病因的多元化影响脑梗死预后及溶栓效价仍无一致性结论。已有研究显示，大动脉粥样硬化型及心源性脑栓塞型病死率高[2]。本研究回顾性分析我院卒中中心溶栓病例，旨在探讨临床评估短期内卒中患者预后，提供指导临床实践经验，更好地開展溶栓治疗，现报道如下。

1 资料与方法

1.1 一般资料

选取我院卒中中心2019年1月至2020年3月溶栓治疗的急性缺血性卒中患者共146例，排除尿激酶溶栓、血管内治疗、死亡21例，失访7例，入组118例。入院时采集患者的性别、年龄、体重、既往史（高血压病、糖尿病、吸烟史及饮酒史等）。急性脑缺血性卒中诊断均为入院后≤24 h头颅CT或MRI确诊，符合……