Objective: To investigate the relationship between maximal infarct volume to benefit from intravenous thrombolysis (IVT) and onset to needle time (ONT).
Methods: The clinical and image data of acute ischemic stroke patients who received IVT in the second Affiliated Hospital, Zhejiang University School of Medicine during May 2009 to June 2016 were retrospectively reviewed. Patients were classified into within-time-window group (ONT ≤ 4.5 h) and beyond-time-window group (ONT>4.5 h). Good and poor outcome were defined as modified Rankin scale (mRS) ≤ 2 or >2 at 3 months, respectively. The maximal infarct volume was analyzed by receiver operating characteristic (ROC) curve.
Results: Among 587 patients (465 cases were within-time-window, 122 cases were beyond-time-window), baseline core volume was 15(2-46)mL,and 324 (55.2%) patients achieved good outcome. Compared with the good-outcome group, the baseline core volume was larger in the poor-outcome group (32 mL vs 5 mL,Z=-9.766,P<0.01). After adjusting age, ONT, baseline National Institutes of Health Stroke Scale (NIHSS) and atrial fibrillation, baseline infarct core volume independently predicted poor outcome (OR=1.014, 95% CI:1.008-1.020, P<0.01). The ROC curve analysis showed that the maximal infarct core volume for achieving good outcome in the within-time-window group and beyond-time-window group were 152 mL and 71mL, respectively. The maximal infarct volume to benefit from IVT diminished with the increasing delayed ONT of every 30 min (ρ=-0.691, P<0.05).
Conclusions: The maximal infarct volume to benefit from thrombolysis is larger in patients treated within time window than those beyond the time window, and that volume diminishes with ONT delay.
目的: 探究静脉溶栓治疗获益的最大梗死体积阈值及其与急性缺血性卒中患者发病时间的关系。
方法: 回顾性分析2009年5月至2016年6月发病9 h内在浙江大学医学院附属第二医院接受静脉溶栓治疗的急性缺血性卒中患者的临床及影像学资料。按起病至静脉溶栓时间（ONT）将患者分成时间窗内组（ONT ≤ 4.5 h）和超时间窗组（ONT>4.5 h），三个月临床预后采用改良Rankin评分（mRS）评估，mRS ≤ 2定义为预后良好，mRS>2定义为预后不良。利用受试者工作特征（ROC）曲线计算静脉溶栓治疗获益的最大梗死体积阈值。
结果: 共纳入587例急性缺血性卒中患者，时间窗内465例，超时间窗122例。相对于临床预后良好者，临床预后不良者基线梗死体积较大（ Z=-9.766， P < 0.01）。校正年龄、ONT、基线美国国立卫生研究院卒中量表（NIHSS）评分、心房颤动后，较大基线梗死体积是预后不良的独立影响因素（ OR=1.014，95% CI：1.008~1.020， P < 0.01）。根据ROC曲线，时间窗内患者和超时间窗患者静脉溶栓获益的最大梗死体积阈值分别为152 mL（曲线下面积为0.733，95% CI：0.686~0.779， P < 0.01）和71 mL（曲线下面积为0.732，95% CI：0.644~0.820， P < 0.01）。随着ONT延长，梗死体积阈值减小（ ρ=-0.691， P < 0.05）。
结论: 相对于超时间窗的缺血性卒中患者，时间窗内的患者从静脉溶栓中获益的梗死体积阈值更高，其阈值随时间延长而减小。