目的:这项研究调查了美国国立卫生研究院卒中量表(NIHSS)评分与Alberta卒中计划早期CT评分(ASPECTS)测量的计算机断层扫描(CT)结果之间的不匹配,以预测急性缺血性卒中(AIS)患者静脉溶栓(IVT)治疗的功能结果和安全性。
方法:这项前瞻性观察性研究包括AIS患者,这些患者在症状出现4.5小时内接受了CT成像。患者分为NIHSS-ASPERTS错配(NAM)阳性和NAM阴性组(P组和N组,分别)。使用改良的Rankin量表(mRS)评估临床结果。安全性结果包括进展,症状性脑出血(sICH),脑出血(ICH),不良事件,临床不良事件,和死亡率。
结果:共208例患者纳入研究。P组,IVT治疗在3个月(p=0.005)和1年(p=0.001)时与良好的功能预后相关。在接受IVT治疗的P组中,在1年时,mRS(0-2)(p=0.01)和mRS(0-1)(p=0.011)功能结局良好的患者百分比更高。N组未从相同的治疗中受益(3个月和1年时p=0.352和p=0.480,分别)。sICH差异无统计学意义,ICH,死亡率,或IVT和常规治疗组之间的其他风险。
结论:IVT治疗与NAM患者的良好功能预后相关,在不增加sICH风险的情况下,ICH,死亡率,或其他负面结果。NAM有望成为指导AIS治疗决策的容易获得的指标。
OBJECTIVE: This study investigates the mismatch between the National Institutes of Health Stroke Scale (NIHSS) score and the computed tomography (CT) findings measured by the Alberta Stroke Program Early CT Score (ASPECTS) for predicting the functional outcome and safety of intravenous thrombolysis (
IVT) treatment in patients with acute ischemic stroke (AIS).
METHODS: This prospective observational study includes patients with AIS who underwent CT imaging within 4.5 h of the onset of symptoms. Patients were divided into the NIHSS-ASPECTS mismatch (NAM)-positive and NAM-negative groups (group P and N, respectively). The clinical outcome was assessed using the Modified Rankin Scale (mRS). Safety outcomes included progression, symptomatic intracerebral hemorrhage (sICH), intracerebral hemorrhage (ICH), adverse events, clinical adverse events, and mortality.
RESULTS: A total of 208 patients were enrolled in the study. In group P,
IVT treatment was associated with a good functional outcome at 3 months (p = 0.005) and 1 year (p = 0.001). A higher percentage of patients with favorable mRS (0-2) (p = 0.01) and excellent mRS (0-1) (p = 0.011) functional outcomes was obtained at 1 year in group P with
IVT treatment. Group N did not benefit from the same treatment (p = 0.352 and p = 0.480 at 3 months and 1 year, respectively). There were no statistically significant differences in sICH, ICH, mortality rates, or other risks between the
IVT and conventional treatment groups.
CONCLUSIONS: IVT treatment is associated with a good functional outcome in patients with NAM, without increasing the risks of sICH, ICH, mortality, or other negative outcomes. NAM promises to be an easily obtained indicator for guiding the treatment decisions of AIS.