Predictors of good outcome after intravenous tPA for acute ischemic stroke
Predictors of good outcome after intravenous tPA for acute ischemic stroke
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DOI：
10.1212/wnl.57.3.474
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发表时间：
2001-08-14
期刊：
影响因子：
9.9
通讯作者：
Levine, SR
中科院分区：
文献类型：
--
作者：
Demchuk, AM;Tanne, D;Levine, SR
背景：静脉注射阿替普酶用于急性缺血性卒中的溶栓治疗在北美日益成熟，但在其他地区尚未确立。国家神经疾病和卒中研究所tPA卒中研究组未确定改变阿替普酶应答的基线因素。研究方法：作者从美国、加拿大和德国的研究中心收集了1，205例接受IV阿替普酶治疗的急性缺血性卒中患者的信息。目的是使用多变量逻辑回归模型确定预测良好结局的独立因素。改良兰金量表评分分为良好结局（mRS 0 - 1）和不良结局（mRS >1）作为主要结局指标。结果如下：按照相对降序排列，基线卒中严重程度较轻、无糖尿病史、CT扫描正常、治疗前血糖水平正常和治疗前血压正常是接受IV阿替普酶治疗急性缺血性卒中患者结局良好的独立预测因素。在糖尿病史、CT扫描表现、基线血糖水平和血压之间观察到混杂因素，表明这些变量之间存在重要关系。结论：几个因素独立预测阿替普酶治疗急性缺血性卒中患者的良好结局。这些结果在临床实施之前需要进一步确认。
Background: Thrombolytic therapy for acute ischemic stroke with IV alteplase is increasingly well established in North America but not elsewhere. Baseline factors that altered the response to alteplase were not identified by the National Institute of Neurological Disorders and Stroke tPA Stroke Study Group. Methods: The authors gathered information from centers in the United States, Canada, and Germany on 1,205 patients with acute ischemic stroke treated with IV alteplase. The purpose was to identify independent factors that were predictive of good outcome using multivariable logistic regression modelling. The modified Rankin Scale score was dichotomized into good outcome (mRS 0 to 1) and poor outcome (mRS >1) as the primary outcome measure. Results: In relative order of decreasing magnitude, milder baseline stroke severity, no history of diabetes mellitus, normal CT scan, normal pretreatment blood glucose level, and normal pretreatment blood pressure were independent predictors of good outcome among patients treated with IV alteplase for acute ischemic stroke. Confounding was observed among history of diabetes mellitus, CT scan appearance, baseline serum glucose level, and blood pressure, suggesting important relationships among these variables. Conclusions: Several factors were independently predictive of good outcome among patients with acute ischemic stroke treated with alteplase. These results require further confirmation before clinical implementation.