目的：探讨高龄脑梗死患者接受标准剂量重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）静脉溶栓治疗的疗效和安全性。方法对我院2011年1月～2013年12月连续收治入院的254例急性脑梗死患者的临床资料进行回顾性分析，分为老龄溶栓组118例（60＜年龄≤80岁，rt-PA静脉溶栓治疗）；高龄溶栓组62例（年龄＞80岁， rt-PA静脉溶栓治疗）；高龄非溶栓组74例（年龄＞80岁，非rt-PA静脉溶栓治疗）。比较3组入院前的一般情况，溶栓治疗前美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分，溶栓后出血转化率及治疗7 d内致死性出血率，治疗后90 d改良Rankin量表（modifed Rankin Scale，mRS）评分和90 d的病死率。结果老龄溶栓组、高龄溶栓组和高龄非溶栓组治疗前NIHSS评分（13.0±5.3、15.1±6.6、14.1±6.6；P=0.523）无显著差异，3组的急性期事件出血转化率分别为16.9%、20.9%和21.6%，P=0.675；3组7 d内致死性出血的发生率分别为3.3%，9.6%，7.4%，P=0.20。90 d内的病死率分别为11.0%，22.6%，16.2%，P=0.12。老龄溶栓组和高龄溶栓组治疗后90 d的mRS评分0～2比值分别为56.8%和38.7%，两组比值比（odds ratio，OR）为2.08；95%可信区间（confidence interval，CI）为1.11～3.86，P=0.021；两组治疗后90 d mRS评分中位数比较：2 vs 3，P=0.025。高龄溶栓组和高龄非溶栓组90 d的mRS评分0～2比值分别为38.7%和21.6%，OR 1.81，95%CI 0.80～4.06，P=0.098；90 d mRS评分中位数比较：3 vs 5，P=0.008。结论与未溶栓的高龄患者相比，急性缺血性卒中老龄和高龄患者接受rt-PA治疗不增加急性期出血转化率和病死率。老龄组比高龄组rt-PA治疗获益大，高龄溶栓组比非溶栓组获益大。高龄组rt-PA治疗可以改善患者90 d生活自理能力且不增加病死率。%Objective To investigate the safety and effectiveness of recombinant tissue plasminogen activator (rt-PA) therapy without endovascular therapy for acute ischemic stroke (AIS) patients (≥80 years old). Methods The data were collected from January 2011 to December 2013. Intravenous rt-PA was administered to patients within 4.5 hours of stroke onset. The patients who received rt-PA therapy were stratiifed into two age groups:an old group (n=118,>60 and<80 years) and an elder group (n=62, ≥80 years) and the other elder group without rt-PA therapy (n=74, ≥80 years). The National Institutes of Health Stroke Scale (NIHSS) scores between three groups were compared before thrombolysis. The incidence of hemorrhage transformation (HT), incidence of fatal intracerebral hemorrhage (ICH) within 7 days, mortality and modiifed Rankin Scale (mRS) score at 90 days were examined. Results There is no difference of NIHSS score between groups (13.0±5.3 vs 15.1±6.6 vs 14.1±6.6;P=0.523). The incidence of fatal ICH within 7 days was also not significantly different (3.3%vs 9.6%vs 7.4%, P<0.2). Odds ratio was 2.08, 95% confidence interval (CI) was 1.11~3.86 for mRS 0 to 2 at 90 days between rt-PA therapy groups (P=0.021);The median of mRS score was signiifcantly higher 2(1~3) vs 3(1~5), P=0.025. Odds Ratio was 1.81, 95%CI was 0.8~4.06 between the elder groups with or without rt-PA therapy (P=0.098). The median of mRS score 3(1~5) vs 5(2~5), P=0.008. There are no difference of 90-day mortality in the three groups (11%vs 22.6%vs 16.2%;P=0.12). Conclusion rt-PA therapy appears to be as safe for AIS patients≥80 years as it is for old patients. Elder patients still could beneift from rt-PA therapy, though not as effective as old patients. This therapy should not be withheld because of age.
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