Uric acid therapy improves the outcomes of stroke patients treated with intravenous tissue plasminogen activator and mechanical thrombectomy
Uric acid therapy improves the outcomes of stroke patients treated with intravenous tissue plasminogen activator and mechanical thrombectomy
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DOI：
10.1177/1747493016684354
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发表时间：
2017-06-01
影响因子：
6.7
通讯作者：
Planas, Anna M.
中科院分区：
文献类型：
--
作者：
Chamorro, Angel;Amaro, Sergio;Planas, Anna M.
背景：许多神经保护药物在急性缺血性卒中的治疗中未能显示出疗效，因此寻找新的治疗方法势在必行。尿酸是一种内源性抗氧化剂，可作为改善卒中预后的候选药物。目的报告尿酸治疗对接受静脉溶栓和机械取栓治疗的中风患者的疗效。方法45例纳入URICO-ICTUS试验的近端血管闭塞患者在发病4.5h内接受重组组织型纤溶酶原激活剂静脉注射，并随机分为尿酸1000 mg组和安慰剂组(NCT00860366)。这些患者还接受了机械血栓切除术，因为脑部计算机断层血管造影术证实在全身溶栓结束时缺乏近端再通。主要结果是90天后功能恢复良好(改良Rankin评分0-2)。结果尿酸组和安慰剂组血管重建成功率为80%，尿酸组和安慰剂组分别为16例(67%)和10例(48%)(调整优势比，6.12，95%可信区间1.08-34.56)。24名接受尿酸治疗的患者中有2名(8.3%)死亡，21名接受安慰剂治疗的患者中有1名(4.8%)死亡(调整后的优势比为3.74(95%可信区间0.06-226.29))。两组患者的症状、脑出血和痛风发作相似。结论尿酸治疗是安全的，可改善接受静脉溶栓加血栓清除术的卒中患者的预后。在更大规模的试验中验证这一简单的策略是当务之急。
Background Numerous neuroprotective drugs have failed to show benefit in the treatment of acute ischemic stroke, making the search for new treatments imperative. Uric acid is an endogenous antioxidant making it a drug candidate to improve stroke outcomes.Aim To report the effects of uric acid therapy in stroke patients receiving intravenous thrombolysis and mechanical thrombectomy.Methods Forty-five patients with proximal vessel occlusions enrolled in the URICO-ICTUS trial received intravenous recombinant tissue plasminogen activator within 4.5h after stroke onset and randomized to intravenous 1000mg uric acid or placebo (NCT00860366). These patients also received mechanical thrombectomy because a brain computed tomogaphy angiography confirmed the lack of proximal recanalization at the end of systemic thrombolysis. The primary outcome was good functional outcome at 90 days (modified Rankin Score 0-2). Safety outcomes included mortality, symptomatic intracerebral bleeding, and gout attacks.Results The rate of successful revascularization was >80% in the uric acid and the placebo groups but good functional outcome was observed in 16 out of 24 (67%) patients treated with uric acid and 10 out of 21 (48%) treated with placebo (adjusted Odds Ratio, 6.12 (95% CI 1.08-34.56)). Mortality was observed in two out of 24 (8.3%) patients treated with uric acid and one out of 21 (4.8%) treated with placebo (adjusted Odds Ratio, 3.74 (95% CI 0.06-226.29)). Symptomatic cerebral bleeding and gout attacks were similar in both groups.Conclusions Uric acid therapy was safe and improved stroke outcomes in stroke patients receiving intravenous thrombolysis followed by thrombectomy. Validation of this simple strategy in a larger trial is urgent.