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目的探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死(AIS)病人近期疗效的中医证型差异及其影响因素。方法回顾性分析103例接受rt-PA静脉溶栓的急性脑梗死病人,比较其不同中医证型间的基线资料,分析急性脑梗死病人溶栓后神经功能及预后的差异。根据14d临床疗效分为优效组和非优效组,采用Logistic回归模型分析中医证型与病人14d结局的关系。结果风痰瘀阻组、阴虚风动组高血压病史比例高于气虚血瘀组,3组比较差异有统计学意义(P=0.013)。3组基线NIHSS评分和溶栓后14dNIHSS评分比较,差异有统计学意义;A组优效率为60.0%,B组优效率为38.2%,C组优效率为27.6%,3组优效率比较差异有统计学意义(P<0.05)。Logistic回归分析显示:中风病中医证型是脑梗死病人溶栓后14d预后是否良好的影响因子(OR=0.495,95%CI 0.292~0.839,P=0.009);年龄是脑梗死病人溶栓后14d的预后是否良好的预测因素(OR=0.950,95%CI 0.910~0.992,P=0.020)。结论不同中医证型急性脑梗死静脉溶栓治疗,短期预后存在差异,且风痰瘀阻型疗效最好。
Objective To investigate the short-term effects of intravenous thrombolysis of recombinant tissue plasminogen activator (rt-PA) on patients with acute cerebral infarction (AIS) and its influencing factors. Methods A retrospective analysis of 103 patients with acute cerebral infarction treated with intravenous rt-PA thrombolytic therapy was performed. The baseline data of different TCM syndromes were compared. The differences of neurological function and prognosis after thrombolysis in patients with acute cerebral infarction were analyzed. According to the clinical efficacy of 14d were divided into excellent effect group and non-optimal effect group, using Logistic regression model to analyze the relationship between TCM syndrome and patient’s 14d outcome. Results The proportions of wind-phlegm-stasis group and yin-deficiency-wind group were higher than those of Qi-deficiency and blood-stasis group. The differences among the three groups were statistically significant (P = 0.013). There was significant difference between the NIHSS score of the three groups and the NIHHSS score of the 14th day after thrombolysis. The excellent efficiency was 60.0% in group A, 38.2% in group B, and 27.6% in group C Statistical significance (P <0.05). Logistic regression analysis showed that TCM syndromes of stroke were the influencing factors on the 14th day after thrombolysis in patients with cerebral infarction (OR = 0.495, 95% CI 0.292-0.839, P = 0.009) (OR = 0.950, 95% CI 0.910 ~ 0.992, P = 0.020). Conclusion Different TCM syndromes of acute cerebral infarction with intravenous thrombolysis, there are differences in short-term prognosis, and phlegm stasis type curative effect best.