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目的探究缺血性卒中患者静脉溶栓后基于美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分的早期神经功能改善(early neurologic improvement,ENI)对患者3个月结局的预测作用。方法本研究的入选患者来自中国急性缺血性卒中溶栓监测登记研究(Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China,TIMS-China),从中选取所有进行溶栓前NIHSS评分、溶栓后2 h和24 h NIHSS评分的患者,将ENI定义为溶栓后2 h NIHSS评分减少≥5分或NIHSS评分等于0分,以及溶栓后24 h NIHSS评分减少≥8分或NIHSS评分等于0分,结局指标包括溶栓后90 d的改良Rankin量表(modified Rankin Scale,m RS)评分、症状性颅内出血(symptomatic intracranial hemorrhage,SICH)情况及患者的死亡率,采用Logistics回归模型分析早期神经功能改善对患者3个月结局的预测作用。结果共纳入1100例患者,在溶栓后2 h,310(28.18%)例患者具有ENI,在溶栓后24 h,272(24.73%)例患者具有ENI。在多因素Logistic回归分析模型中,调整了年龄、心房颤动病史、基线血糖水平、基线NIHSS评分水平及其他相关变量后发现,无论是溶栓后2 h还是溶栓后24 h,ENI组患者与非-ENI组患者相比,均具有更好的3个月良好功能结局(2 h:OR 3.772;95%CI 2.676~5.316,P<0.001;24 h:OR 16.392;95%CI 10.370~25.912,P<0.001)以及更低的死亡率(2 h:OR 0.504;95%CI 0.268~0.950,P=0.034;24 h:OR 0.149;95%CI 0.061~0.366,P<0.001),同时,其出血风险(2 h:OR 1.979;95%CI 0.621~6.301,P=0.248;24 h:OR-;95%CI-,P=0.928)均未增加。结论静脉注射重组组织纤溶酶原激活剂(recombinant tissue-type plasminogen activator,rt-PA)溶栓后早期神经功能改善的缺血性卒中患者具有更加良好的3个月功能预后。
Objective To investigate the effect of early neurologic improvement (ENI) based on the National Institutes of Health Stroke Scale (NIHSS) score after intravenous thrombolysis in patients with ischemic stroke Predict effect. Methods The patients enrolled in this study were all from the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China (TIMS-China). All NIHSS scores before thrombolysis were selected. Two hours after thrombolysis And NIHSS score at 24 h, ENI was defined as a 5-point reduction in NIHSS score or 0 NIHSS score at 2 h after thrombolysis and a NIHSS score reduction of ≥8 or NIHSS score equal to 0 at 24 h after thrombolysis Indicators included modified Rankin Scale (m RS) score, symptomatic intracranial hemorrhage (SICH) and patient mortality at 90 days after thrombolysis. Logistics regression model was used to analyze the early neurological improvement Predictors of 3-month outcomes in patients. Results A total of 1100 patients were enrolled. ENI was present in 310 (28.18%) of the patients at 2 h after thrombolysis, and ENI was found in 272 (24.73%) of the patients at 24 h after thrombolysis. In the multivariate Logistic regression model, adjusted for age, history of atrial fibrillation, baseline blood glucose level, baseline NIHSS score and other related variables found that, whether it is 2 h after thrombolysis or 24 h after thrombolysis, ENI patients and Patients with non-ENI had better 3-month good functional outcome (2 h: OR 3.772; 95% CI 2.676-5.316, P <0.001; 24 h: OR 16.392; 95% CI 10.370-25.912; P <0.001) and lower mortality (2 h: OR 0.504; 95% CI 0.268-0.950, P = 0.034; 24 h: OR 0.149; 95% CI 0.061-0.366, P <0.001) The risk (2 h: OR 1.979; 95% CI 0.621-6.301, P = 0.248; 24 h: OR-; 95% CI-, P = 0.928) did not increase. Conclusions Patients with ischemic stroke with early improvement of neurological function after intravenous injection of recombinant tissue-type plasminogen activator (rt-PA) have a better prognosis for 3 months.