急性卒中患者静脉溶栓后，神经功能随时间有什么变化？
我们知道，静脉溶栓是可以增加急性缺血卒中患者良好预后的。本研究就是来探讨这种良好的预后，随着时间的增加以后，是否依然能够让患者的持续获益。
方法:
我们分析了2006年至2019年在奥地利卒中单元登记处接受r- tpa治疗的患者的数据。改良Rankin评分为0 - 2分定义良好的功能预后。
在整个人群和预先指定的亚组中评估mRS得分为0 - 2分的频率;采用多变量logistic回归分析评估基线特征的相关性，包括临床相关相互作用和预后。
结果:
9409例接受r- tpa治疗的患者中有4865例(51.7%)在卒中后3个月获得了良好的功能结果。2006年至2019年，功能恢复良好的频率从45.9%增加到56.8%。
在多变量logistic回归分析中，治疗年份(调整优势比[adjOR]， 1.08[95% Cl, 1.01-1.15])与良好的功能预后相关。卒中严重程度(美国国立卫生研究院卒中量表，adjOR, 0.86[95% Cl, 0.85-0.87])，年龄(61-70岁:adjOR，0.67 (95% Cl, 0.55 - -0.80), 71 - 80年:adjOR,0.42 [95% cl, 0.35 - -0.501, > 80年:adjOR,0.16[95% CI,0.13-0.20])、女性(adjOR, 0.89[95% CI, 0.79-0.99])和各种共病(如房颤、既往卒中、糖尿病)呈负相关。
将交互项纳入多变量logistic回归模型表明，通过增加卒中严重程度的治疗年份和血管内治疗对功能预后有积极影响(交互作用)卒中量表:adjOR, 1.01 [95% CI，1.00-1.02]，NIHSS与血管内治疗的交互作用:adjOR,1.02[95%Cl,1.01-1.03])。
结论:
随着时间的推移，接受r- tpa治疗的患者的功能预后一直在增加，这可能是由于接受血管内治疗的更严重中风患者的预后改善所致。但是，有些亚组仍然不太可能实现功能独立，值得特别注意。
Temporal Trends of Functional Outcome in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis.
Stroke; a Journal of Cerebral Circulation 2022 Aug 24;:101161STROKEAHA121038400.
BACKGROUND: Intravenous thrombolysis improves functional outcome in patients with acute stroke and frequencies of r-tPA (recombinant tissue-type plasminogen activator) treatment have been increasing over time. We aimed to assess whether functional outcome in r-tPA-treated patients improved over time and to investigate the influence of clinical variables on functional outcome.
METHODS: We analyzed data of r-tPA-treated patients in the Austrian Stroke Unit Registry from2006 to 2019. Favorable functional outcome was defined as modified Rankin Scale score of 0 to 2.
Frequencies of modified Rankin Scale score of 0to 2 were assessed for the overall population and in prespecified subgroups; multivariable logistic regression analysis was performed to assess associations of baseline characteristics including clinically relevant interactions, and outcome.
RESULTS: Overall, 4865 out of 9409 r-tPA-treated patients (51.7%) achieved favorable functional outcome 3 months post stroke. Between 2006and 2019, frequencies of favorable functional outcome increased from 45.9% to 56.8%. In multivariable logistic regression analysis, year of treatment (adjusted odds ratio [adjOR], 1.08[95% Cl, 1.01-1.15]) was associated with favorable functional outcome. Stroke severity (National Institutes of Health Stroke Scale, adjOR, 0.86[95% Cl, 0.85-0.87]), age (61-70 years: adjOR,
0.67[95% Cl,0.55-0.80],71-80 years:adjOR,
0.42[95%Cl,0.35-0.501,>80 years:adjOR,
0.16[95% CI,0.13-0.20]), female sex (adjOR, 0.89[95% CI, 0.79-0.99]), and various comorbidities(eg, atrial fibrillation, prior stroke, diabetes) were negatively associated. Inclusion of interaction terms into the multivariable logistic regression model suggests a positive effect of year of treatment and endovascular treatment by increasing stroke severity on functional outcome (interaction
between year of treatment and National Institutes of Health Stroke Scale: adjOR, 1.01 [95% CI,
1.00-1.02], interaction between National Institutes of Health Stroke Scale and endovascular treatment:adjOR,1.02[95%Cl,1.01-1.03]).
CONCLUSIONS: Frequencies of favorable
functional outcome in r-tPA-treated patients have been increasing over time, likely driven by improved outcome in patients with more severe strokes receiving endovascular treatment. However,some subgroups are still less likely to achieve functional independency and deserve particular attention.
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