急性脑梗死重组组织型纤溶酶原激活物静脉溶栓后严重出血性转化研究进展

王勤鹰,詹 青

神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (1) : 25-31.

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神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (1) : 25-31. DOI: 10.12022/jnnr.2017-0003
综述

急性脑梗死重组组织型纤溶酶原激活物静脉溶栓后严重出血性转化研究进展

  • 王勤鹰,詹 青
作者信息 +

Advances in severe hemorrhagic transformation after intravenous thrombolysis with recombinant tissue plasminogen activator for acute brain infarction

  • WANG Qinying, ZHAN Qing
Author information +
文章历史 +

摘要

严重出血性转化是静脉溶栓治疗最危险的并发症。本文对近年来有关静脉溶栓后严重出血性转化的定义、临床表现、影像学特征以及相关危险因素的研究进展进行综述。对具有严重出血性转化高风险的急性脑梗死患者可以选择低剂量重组组织型纤溶酶原激活物(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗,以降低症状性颅内出血的发生风险。

Abstract

Severe hemorrhagic transformation is a most dangerous complication during thrombolytic therapy for acute ischemic stroke. This paper summarizes the definition, clinical manifestations, imaging characteristics, and the related risk factors of thrombolysis-associated severe hemorrhagic transformation. In acute ischemic stroke patients with high risk of severe hemorrhagic transformation, thrombolytic therapy with a low dose of recombinant tissue plasminogen activator (rtPA) may reduce the risk of symptomatic intracerebral hemorrhage.

关键词

卒中 / 脑梗死 / 急性缺血性卒中 / 溶栓治疗 / 症状性颅内出血 / 出血性转化

Key words

Stroke / Brain infarction / Acute ischemic stroke / Thrombolytic therapy / Symptomatic intracranial hemorrhages / Hemorrhagic transformation

引用本文

导出引用
王勤鹰,詹 青. 急性脑梗死重组组织型纤溶酶原激活物静脉溶栓后严重出血性转化研究进展[J]. 神经病学与神经康复学杂志. 2017, 13(1): 25-31 https://doi.org/10.12022/jnnr.2017-0003
WANG Qinying, ZHAN Qing. Advances in severe hemorrhagic transformation after intravenous thrombolysis with recombinant tissue plasminogen activator for acute brain infarction[J]. Journal of Neurology and Neurorehabilitation. 2017, 13(1): 25-31 https://doi.org/10.12022/jnnr.2017-0003

参考文献

[1] Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)[J]. JAMA, 1995, 274(13):1017-1025.
[2] Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group[J]. N Engl J Med, 1995, 333(24):1581-1587.
[3] Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J]. N Engl J Med, 2008, 359(13):1317-1329.
[4] Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASSII). Second European-Australasian Acute Stroke Study Investigators[J]. Lancet, 1998, 352(9136):1245-1251.
[5] Clark WM, Wissman S, Albers GW, et al. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke[J]. JAMA, 1999, 282(21):2019-2026.
[6] Wahlgren N, Ahmed N, Dávalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study[J]. Lancet, 2007, 369(9558):275-282.
[7] IST-3 collaborative group, Sandercock P, Wardlaw JM, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial[J]. Lancet, 2012, 379(9834):2352-2363.
[8] IST-3 collaborative group. Effect of thrombolysis with alteplase within 6 h of acute ischaemic stroke on long-term outcomes (the third International Stroke Trial [IST-3]): 18-month follow-up of a randomised controlled trial[J]. Lancet Neurol, 2013, 12(8):768-776.
[9] Larrue V, von Kummer RR, Müller A, et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASSII)[J]. Stroke, 2001, 32(2):438-441.
[10] Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials[J]. Lancet, 2004, 363(9411):768-774.
[11] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4):246-257.
[12] Kellert L, Sykora M, Gumbinger C, et al. Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome[J]. Cerebrovasc Dis, 2012, 33(2):135-140.
[13] Ueshima S, Matsuo O. The differences in thrombolytic effects of administrated recombinant t-PA between Japanese and Caucasians[J]. Thromb Haemost, 2002, 87(3):544-546.
[14] Ross AM, Gao R, Coyne KS, et al. A randomized trial confirming the efficacy of reduced dose recombinant plasminogen activator in a Chinese myocardial infarction population and demonstrating superiority to usual dose urokinase: The TUCC trial[J]. Am Heart J, 2001, 142(2):244-247.
[15] Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT)[J]. Stroke, 2006, 37(7):1810-1815.
[16] Chao AC, Hsu HY, Chung CP, et al. Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients: the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) study[J]. Stroke, 2010, 41(5):885-890.
[17] Cronin CA, Shah N, Morovati T, et al. No increased risk of symptomatic intracerebral hemorrhage after thrombolysis in patients with European Cooperative Acute Stroke Study (ECASS) exclusion criteria[J]. Stroke, 2012, 43(6):1684-1686.
[18] Hill MD, Buchan AM; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study[J]. CMAJ, 2005, 172(10):1307-1312.
[19] Tanne D, Kasner SE, Demchuk AM, et al. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey[J]. Circulation, 2002, 105(14):1679-1685.
[20] Ribo M, Montaner J, Molina CA, et al. Admission fibrinolytic profile is associated with symptomatic hemorrhagic transformation in stroke patients treated with tissue plasminogen activator[J]. Stroke, 2004, 35(9):2123-2127.
[21] Inzitari D, Giusti B, Nencini P, et al. MMP9 variation after thrombolysis is associated with hemorrhagic transformation of lesion and death[J]. Stroke, 2013, 44(10):2901-2903.

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