Intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke with high stress hyperglycemia
10.3760/cma.j.cn113694-20210907-00617
- VernacularTitle:重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死伴应激性高血糖的临床研究
- Author:
Yawei GU
1
;
Xu CHU
;
Lan ZHAO
;
Lijun WANG
;
Hongxin WANG
Author Information
1. 南开大学附属第四中心医院神经内科，天津 300140
- Keywords:
Stroke;
Tissue plasminogen activator;
Glycated hemoglobin A1;
Stress hyperglycemia
- From:
Chinese Journal of Neurology
2022;55(3):210-215
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with stress hyperglycemia under the guidance of glycosylated hemoglobin A1c (GHbA1c).Methods:The clinical data of 195 patients of acute cerebral infarction with admission blood glucose over 22.2 mmol/L and GHbA1c less than 15.59% were collected in Nankai University Affiliated Tianjin Fourth Central Hospital from January 2018 to June 2021 and analyzed retrospectively. Patients were divided into control group (60 cases), rt-PA low-dose group (0.6 mg/kg, 70 cases) and rt-PA standard-dose group (0.9 mg/kg, 65 cases) to evaluate the guiding effect of GHbA1c and the efficacy and safety of rt-PA.Results:The effective rate at 24 hours and good rate at 7 days were 61.4% (43/70) and 72.9% (51/70) in the rt-PA low-dose group, 64.6% (42/65) and 69.2% (45/65) in the rt-PA standard-dose group, respectively, both better than the control group [30.0% (18/60); χ2=18.25, P<0.001 and 46.7% (28/60); χ2=13.65, P=0.001]. The good outcome rate at 90 days was 82.8% (58/70) in the rt-PA low-dose group, which was better than 63.3% (38/60) in the control group (χ2=6.38, P=0.016), but without statistically significant difference compared with the rt-PA standard-dose group [72.3% (47/65); χ2=2.17, P=0.153]. The case fatality rate at 90 days of the rt-PA low-dose group was 7.1% (5/70), which was lower than 20.0% (13/65) in the rt-PA standard-dose group (χ2=4.82, P=0.041) and 18.3% (11/60) in the control group (χ2=5.04, P=0.030). The incidence of intracranial hemorrhage and symptomatic intracranial hemorrhage was 8.5% (6/70) and 2.9% (2/70) in the rt-PA low-dose group, lower than 20.0% (13/65; P=0.048) and 13.8% (9/65; P=0.020) in the rt-PA standard-dose group. The incidence of extracranial hemorrhage was 7.1% (5/70) in the rt-PA low-dose group, lower than 18.9% (12/65) in the rt-PA standard-dose group ( P=0.042). Conclusion:Acute cerebral infarction patients with admission blood glucose over 22.2 mmol/L can receive rt-PA treatment when GHbA1c is less than 15.59%, and 0.6 mg/kg dosage is recommended.
