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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?
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Is there a decreased risk of intracerebral hemorrhage and mortality in obese patients treated with intravenous thrombolysis in acute ischemic stroke?

机译：在急性缺血性卒中中，通过静脉溶栓治疗的肥胖患者的脑出血和死亡风险降低了吗？

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Background: The current guidelines do not recommend increasing the dose of intravenous recombinant tissue plasminogen activator (IV rt-PA) for ischemic stroke patients weighing >100 kg. Obese patients are therefore receiving an IV rt-PA dose <0.9 mg/kg; however, the consequences of such underdosing are unknown. Our goal was to determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: Data from all patients admitted to US hospitals between 2002 and 2009 who were treated with IV thrombolysis and who had a primary discharge diagnosis of stroke were included. The effect of obesity on rates of intracerebral hemorrhage and discharge outcomes was analyzed after adjusting for potential confounders using logistic regression analysis. Results: Of the 81,579 patients with ischemic stroke treated with IV rt-PA, 5174 (6.3%) were categorized as obese. The intracerebral hemorrhage rates in obese and nonobese patients were significantly different (4.5% v 6.3%; P = .01). After adjusting for age, sex, presence of hypertension, diabetes mellitus, location/teaching status and All Patient Refined Diagnosis Related Group severity scale, there was no difference in the rates of no to minimal disability between obese and nonobese patients (odds ratio [OR] 1.0; 95% confidence interval [CI] 0.8-1.2; P =.8). Obese patients had lower odds of in-hospital mortality (OR 0.6; 95% CI 0.5-0.8; P =.001) but also more likely to be discharged with moderate to severe disability (OR 1.2; 95% CI 1.01-1.3; P =.03). Conclusions: Obese patients receiving IV rt-PA treatment for acute ischemic stroke appear to have a higher survival rate most likely related to their decreased rates of intracerebral hemorrhage.
机译：背景：当前指南不建议对于体重> 100 kg的缺血性中风患者增加静脉内重组组织纤溶酶原激活剂（IV rt-PA）的剂量。因此，肥胖患者接受的静脉rt-PA剂量<0.9 mg / kg;但是，这种剂量不足的后果尚不清楚。我们的目标是确定接受IV rt-PA治疗的急性缺血性中风患者的肥胖与临床结局之间的关系。方法：包括2002年至2009年间在美国医院住院并经静脉溶栓治疗并初步诊断为中风的所有患者的数据。使用Logistic回归分析调整潜在的混杂因素后，分析了肥胖对脑出血和出院结局的影响。结果：在接受IV rt-PA治疗的81,579例缺血性中风患者中，有5174例（6.3％）被归类为肥胖。肥胖和非肥胖患者的脑出血率有显着差异（4.5％对6.3％; P = 0.01）。在调整了年龄，性别，高血压的存在，糖尿病，位置/教学状态以及所有患者细化诊断相关组的严重程度量表后，肥胖和非肥胖患者的无至最小残疾比率没有差异（优势比[OR ; 1.0; 95％置信区间[CI] 0.8-1.2; P ＝ 0.8）。肥胖患者的院内死亡几率较低（OR 0.6; 95％CI 0.5-0.8; P = .001），但更有可能因中度至重度残疾出院（OR 1.2; 95％CI 1.01-1.3; P = .03）。结论：接受IV rt-PA治疗的急性缺血性卒中的肥胖患者似乎具有较高的生存率，这很可能与他们的脑出血率降低有关。

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