文章摘要
王爽, ，张蕾, ，张之悦, ，黎逢光.急性缺血性卒中患者发病前口服抗血小板药物对rt-PA静脉溶栓治疗的影响[J].神经损伤功能重建,2025,(3):134-138
急性缺血性卒中患者发病前口服抗血小板药物对rt-PA静脉溶栓治疗的影响
The Effect of Oral Antiplatelet Medication Administration Prior to Onset on rt-PAIntravenous Thrombolysis in Patients with Acute Ischemic Stroke
  
DOI：
中文关键词: 抗血小板药物  静脉溶栓  急性缺血性卒中  阿替普酶
英文关键词: anti-platelet drugs  intravenous thrombolysis  acute ischemic stroke  Alteplase
基金项目:湖北省自然科学基 金（三嵌段共聚物纳 米胶束包载姜黄素 通 过 抑 制 lncRNA GAS5 调 控 NF-κ B 信号通路减轻脑缺 血损伤的实验研究， No. 2021CFB585）； 湖北省卫健委资助 项目（急性大动脉粥 样硬化性脑梗死患 者 血 浆 外 泌 体 中 lncRNA表达谱变化 及其作用机制研究， No. WJ2021M030）
作者单位
王爽1,2 ，张蕾1,2 ，张之悦1,2 ，黎逢光1 1. 武汉科技大学附 属普仁医院神经内 科 2. 武汉科技大学医 学部医学院 
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中文摘要:
      目的：探讨发病前口服抗血小板药物对急性缺血性卒中（AIS）患者rt-PA静脉溶栓治疗疗效和安全性 的影响。方法：回顾性纳入2020年1月至2023年1月期间，武汉科技大学附属普仁医院经rt-PA静脉溶栓治 疗的209例AIS患者，根据患者发病前24 h内是否口服抗血小板药物，分为溶栓前正在口服抗血小板药物 （有抗组）53例和未服用抗血小板药物（无抗组）156例，比较患者溶栓治疗前、溶栓后24 h和溶栓后7 d的美 国国立卫生研究院卒中量表（NIH stroke scale，NIHSS）以评估近期疗效，通过患者溶栓后 90 d 时的改良 Rankin量表（modified Rankin scale，mRS）评价远期预后，记录患者各部位出血发生率和死亡率评估治疗安 全性。结果：2组患者的一般资料差异无统计学意义（P＞0.05）。有抗组在静脉溶栓后24 h、7 d的预后良好 率分别为49.1%（26/53）、75.5%（40/53）；无抗组静脉溶栓后24 h、7 d的预后良好率为41.7%（65/156）、72.4% （113/156）；有抗组90 d预后优秀率54.7%（29/53）、90 d预后良好率75.5%（40/53）；无抗组90 d预后优秀率 59.0%（92/156）、90 d预后良好率80.8%（126/156）；2组患者在溶栓治疗后的近期疗效、远期预后方面比较差 异无统计学意义（P＞0.05）。有抗组和无抗组的出血发生率分别是15.1%、11.5%，有抗组死亡率为5.7%，无 抗组死亡率为1.9%，2组患者出血发生及死亡比较差异无统计学意义（P＞0.05）。多元Logistic回归分析表 明，溶栓治疗前的NIHSS评分是影响AIS患者远期预后的危险因素（OR=1.293，95% CI 1.181～1.415，P＜ 0.001），抗血小板药物服用史与 AIS 患者远期预后及出血无关（OR=1.182，95% CI 0.505～2.765，P= 0.700）。结论：口服抗血小板药物史对AIS患者静脉溶栓治疗的临床疗效无明显影响，亦不会增加患者溶 栓后的出血风险和死亡率。
英文摘要:
      To investigate the impact of oral antiplatelet medication administration prior to onset on the efficacy and safety of rt-PA intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods: A retrospective analysis was conducted on 209 AIS patients who underwent rt-PA intravenous thrombolysis at Puren Hospital Affiliated to Wuhan University of Science and Technology between January 2020 and January 2023. Based on whether the patients had taken oral antiplatelet medication within 24 hours before onset, they were divided into two groups: the antiplatelet group (53 patients who were taking antiplatelet medication before thrombolysis) and the non-antiplatelet group (156 patients who did not take antiplatelet medication). The National Institutes of Health Stroke Scale (NIHSS) was used to assess the short-term efficacy before thrombolysis, at 24 hours post-thrombolysis, and at 7 days post-thrombolysis. The modified Rankin Scale (mRS) at 90 days post-thrombolysis was used to evaluate long-term prognosis. The incidence of bleeding at various sites and mortality rates were recorded to assess treatment safety. Results: There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). In the antiplatelet group, the good prognosis rates at 24 hours and 7 days post-thrombolysis were 49.1% (26/53) and 75.5% (40/53), respectively. In the non-antiplatelet group, the corresponding rates were 41.7% (65/156) and 72.4% (113/156). The excellent prognosis rate at 90 days was 54.7% (29/53) and the good prognosis rate was 75.5% (40/53) in the antiplatelet group, compared to 59.0% (92/156) and 80.8% (126/156) in the non-antiplatelet group. There were no statistically significant differences in short-term efficacy and long-term prognosis between the two groups after thrombolysis (P>0.05). The incidence of bleeding was 15.1% in the antiplatelet group and 11.5% in the non-antiplatelet group, while the mortality rates were 5.7% and 1.9%, respectively. There were no statistically significant differences in bleeding incidence and mortality between the two groups (P>0.05). Multivariate Logistic regression analysis showed that the NIHSS score before thrombolysis was a risk factor for long-term prognosis in AIS patients (OR=1.293, 95% CI 1.181～1.415, P<0.001). History of antiplatelet medication use was not associated with long-term prognosis or bleeding in AIS patients (OR=1.182, 95% CI 0.505～2.765, P=0.700). Conclusion: The history of oral antiplatelet medication has no significant impact on the clinical efficacy of intravenous thrombolysis in AIS patients and does not increase the risk of bleeding or mortality after thrombolysis.
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