Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke
Safety and efficacy of remote ischemic postconditioning after thrombolysis in patients with stroke
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DOI：
10.1212/wnl.0000000000010884
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发表时间：
2020-12-15
期刊：
影响因子：
9.9
通讯作者：
Luo, Guo-gang
中科院分区：
文献类型：
--
作者：
An, Jia-qi;Cheng, Ya-wen;Luo, Guo-gang
目的探讨远程缺血后处理（RIPC）对急性缺血性脑卒中（AIS）患者静脉溶栓（IVT）的疗效。RIPC组患者在住院期间接受RIPC治疗（IVT后）。主要终点为第90天时改良兰金量表（mRS）评分为0或1分。的安全性，耐受性，和与RIPC相关的神经保护生物标志物也evaluated.ResultsWe收集的数据从两个RIPC组（n = 34）和对照组（n = 34）。平均住院时间为11.2天。入院时两组间NIH卒中量表评分（p = 0.364）或发生至治疗时间（p = 0.889）无显著差异。RIPC组71.9%的患者在3个月时获得了良好的恢复（mRS评分0-1），对照组为50.0%（校正比值比9.85，95%置信区间1.54-63.16; p = 0.016）。RIPC组血浆S100-β水平显著低于对照组（P = 0.007），血管内皮生长因子水平显著高于对照组（P = 0.003）。结论反复RIPC联合IVT可显著促进AIS患者神经功能恢复，改善临床预后。ClinicalTrials.gov该研究提供了IV级证据，证明AIS的组织纤溶酶原激活剂治疗后的RIPC显著增加了90天时MRS评分为0或1的患者比例。
ObjectiveTo determine the effect of remote ischemic postconditioning (RIPC) on patients with acute ischemic stroke (AIS) undergoing IV thrombolysis (IVT).MethodsA single-center randomized controlled trial was performed with patients with AIS receiving IVT. Patients in the RIPC group were administered RIPC treatment (after IVT) during hospitalization. The primary endpoint was a score of 0 or 1 on the modified Rankin scale (mRS) at day 90. The safety, tolerability, and neuroprotection biomarkers associated with RIPC were also evaluated.ResultsWe collected data from both the RIPC group (n = 34) and the control group (n = 34). The average duration of hospitalization was 11.2 days. There was no significant difference between 2 groups at admission for the NIH Stroke Scale score (p = 0.364) or occur-to-treatment time (p = 0.889). Favorable recovery (mRS score 0-1) at 3 months was obtained in 71.9% of patients in the RIPC group vs 50.0% in the control group (adjusted odds ratio 9.85, 95% confidence interval 1.54-63.16; p = 0.016). We further found significantly lower plasma S100-beta (p = 0.007) and higher vascular endothelial growth factor (p = 0.003) levels in the RIPC group than in the control group.ConclusionsRepeated RIPC combined with IVT can significantly facilitate recovery of nerve function and improve clinical prognosis of patients with AIS. ClinicalTrials.gov identifier NCT03218293.Classification of evidenceThis study provides Class IV evidence that RIPC after tissue plasminogen activator treatment of AIS significantly increases the proportion of patients with an MRS score of 0 or 1 at 90 days.