Stroke:静脉溶栓治疗后急性缺血性卒中患者脑水肿的预测因素分析!

2017-08-16 xing.T MedSci原创

由此可见,早期CED最重要的基线预测因素包括国立卫生院卒中量表、动脉高密度征、高血糖、意识水平下降以及基线的梗死特征。这一发现可用于改善患者对药物或外科治疗的选择和监测。

脑水肿(CED)是急性缺血性脑卒中的严重并发症。脑梗塞后发生CED的预测具有不确定性。近日,卒中领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在明确哪些基线临床和影像学参数可以预测接受静脉溶栓治疗后的患者CED的发生。

研究人员采用基于图像的方法在静脉溶栓术后通过图像扫描将CED的严重程度分为三类(不太严重的CED1和最严重的CED3)。研究人员提取了2002年至2011年期间在SITS国际登记中心记录的42187名患者数据。研究人员将有CED和无CED的患者的基线数据进行了单变量比较,并采用Logistic回归来选择每个CED严重程度的预测因子。

研究人员在9579/42187例患者中检测到了CED(22.7%:12.5%为CED1,1 4.9%为CED2,5.3%为CED3)。相比于无CED的患者,CED患者基础美国国立卫生院卒中量表评分较高(17 vs. 10;P<0.001),急性心肌梗死的迹象更加常见(27.9% vs. 19.2%;P<0.001),动脉高密度征也更多(37.6% vs. 14.6%;P<0.001),血糖更高(6.8 vs. 6.4mmol/L;P<0.001)。基础美国国立卫生院卒中量表、动脉高密度征、血糖、意识障碍以及成像上的急性梗塞特征是所有水肿类型的独立预测因子。

由此可见,早期CED最重要的基线预测因素包括国立卫生院卒中量表、动脉高密度征、高血糖、意识水平下降以及基线的梗死特征。这一发现可用于改善患者对药物或外科治疗的选择和监测。

原始出处:


Magnus Thorén,et al. Predictors for Cerebral Edema in Acute Ischemic Stroke Treated With Intravenous Thrombolysis.Stroke. 2017. https://doi.org/10.1161/STROKEAHA.117.018223

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createdBy=1072181, createdName=wjywjy, createdTime=Mon Jan 22 20:04:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720193, encodeId=8a941e201937e, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Tue May 29 10:04:00 CST 2018, time=2018-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1892924, encodeId=1ed018929248d, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Aug 19 22:04:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697519, encodeId=1284169e5196f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sat Mar 17 17:04:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259598, encodeId=f4e612595987e, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, 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href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418553, encodeId=d17c1418553d7, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537577, encodeId=5da1153e5777d, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1806175, encodeId=eaa118061e5d8, content=<a href='/topic/show?id=b649e9358fa' target=_blank style='color:#2F92EE;'>#缺血性卒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79358, encryptionId=b649e9358fa, topicName=缺血性卒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=636e2500187, createdName=12498da4m32(暂无昵称), createdTime=Sat Nov 11 10:04:00 CST 2017, time=2017-11-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2010370, encodeId=e81d20103e085, content=<a href='/topic/show?id=9cf7e9360d2' target=_blank style='color:#2F92EE;'>#缺血性卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=16, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79360, encryptionId=9cf7e9360d2, topicName=缺血性卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1072181, createdName=wjywjy, createdTime=Mon Jan 22 20:04:00 CST 2018, time=2018-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720193, encodeId=8a941e201937e, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Tue May 29 10:04:00 CST 2018, time=2018-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1892924, encodeId=1ed018929248d, content=<a href='/topic/show?id=c738e93521f' target=_blank style='color:#2F92EE;'>#缺血性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79352, encryptionId=c738e93521f, topicName=缺血性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=66ec123, createdName=guihongzh, createdTime=Sat Aug 19 22:04:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1697519, encodeId=1284169e5196f, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sat Mar 17 17:04:00 CST 2018, time=2018-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259598, encodeId=f4e612595987e, content=<a href='/topic/show?id=1d2f8490308' target=_blank style='color:#2F92EE;'>#脑水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264255, encodeId=c6c212642550e, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333373, encodeId=01d913333e3b0, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418553, encodeId=d17c1418553d7, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537577, encodeId=5da1153e5777d, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=)]
    2018-03-17 fusion
  6. 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  7. 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objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264255, encodeId=c6c212642550e, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333373, encodeId=01d913333e3b0, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418553, encodeId=d17c1418553d7, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, 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  8. 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objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84903, encryptionId=1d2f8490308, topicName=脑水肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=148754, createdName=gaoxiaoe, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1264255, encodeId=c6c212642550e, content=<a href='/topic/show?id=daf1100226fb' target=_blank style='color:#2F92EE;'>#预测因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100226, encryptionId=daf1100226fb, topicName=预测因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a57b78, createdName=朱睿睿, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1333373, encodeId=01d913333e3b0, content=<a href='/topic/show?id=4ce26423802' target=_blank style='color:#2F92EE;'>#水肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64238, encryptionId=4ce26423802, topicName=水肿)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKCRibWHQArPHdSkqP90U1HwwqlGeU7BUgzY240D3v2ibBDJ09ybkGkwOjxz7qRmngZaGlK1taX6hfA/132, createdBy=2e772500094, createdName=小华子, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1418553, encodeId=d17c1418553d7, content=<a href='/topic/show?id=b88266482f7' target=_blank style='color:#2F92EE;'>#溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66482, encryptionId=b88266482f7, topicName=溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=00673387794, createdName=lqvr, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537577, encodeId=5da1153e5777d, content=<a href='/topic/show?id=221799151b3' target=_blank style='color:#2F92EE;'>#静脉溶栓治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99151, encryptionId=221799151b3, topicName=静脉溶栓治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4e9812877003, createdName=bettycmoon, createdTime=Fri Aug 18 07:04:00 CST 2017, time=2017-08-18, status=1, ipAttribution=)]
    2017-08-18 小华子
  9. 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    2017-08-18 lqvr
  10. 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