Background Stroke represents the second leading cause of death in the world after myocardial infarction. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (alteplase, rt-PA) is the only pharmacological therapy that was approved for treatment within 4.5 h of acute ischemic stroke (AIS) onset. We aimed to predict the 3-month outcome of AIS patients who received alteplase regarding mortality, spontaneous intra-cerebral hemorrhage (sICH), and functional outcome in comparison with non-thrombolyzed patients and to evaluate the predictors of the outcome after 3 months. Methods All the clinical, National Institute of Health Stroke Scale (NIHSS) scores, radiological, and laboratory data of 40 AIS patients and received rt-PA during the period from 2016 to 2018 were collected and analyzed retrospectively. For comparison, 40 patients, as a control group, were selected to match the alteplase group as regards the baseline data and received regular treatment, rather than rt-PA within the first 24 h, that were obtained. The outcome of the thrombolyzed patients after 3 months was evaluated in comparison with controls by using a modified ranking scale. Results After a 90-day follow-up period, the death rate was slightly higher among the rt-PA group (7.5%) in comparison with the control group (5%). sICH occurred in 7.5% of the patients in the alteplase group and in 5% of the non-thrombolyzed patients; however, this difference was not significant. More patients had a favorable outcome (mRS = 0–2) in the rt-PA group than in the control group (65% vs 60%, OR 1.38, 95% CI 0.50–3.6, P = 0.51). NIHSS score on admission, body mass index (BMI) (≥ 30), and previous transient ischemic attacks (TIA)/previous ischemic stroke were significant predictors of outcome after IV thrombolysis. Age, sex, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, smoking, atrial fibrillation (AF), stroke subtype, size of infarction, and hyperdense middle cerebral artery had a non-significant effect. Conclusion After 3 months of follow-up, rt-PA had a non-significant more increase of favorable outcome with increased risk of sICH and death than controls. Baseline NIHSS, BMI, and history of TIA or previous ischemic stroke were significant predictors of outcome after thrombolysis.

中文翻译：

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溶栓治疗后缺血性卒中患者的短期结果

背景中风是继心肌梗塞之后世界上第二大死亡原因。使用重组组织纤溶酶原激活剂（阿替普酶，rt-PA）进行静脉（IV）溶栓是唯一被批准用于急性缺血性卒中（AIS）发病后 4.5 小时内治疗的药物疗法。我们旨在预测接受阿替普酶治疗的 AIS 患者在死亡率、自发性脑出血 (sICH) 和功能结果方面与非血栓溶解患者相比的 3 个月结果，并评估 3 个月后结果的预测因素。方法 对2016-2018年间接受rt-PA治疗的40例AIS患者的临床、美国国立卫生研究院卒中量表（NIHSS）评分、放射学和实验室数据进行回顾性分析。作为比较，40 名患者，作为对照组，在基线数据方面选择与阿替普酶组匹配并接受常规治疗，而不是在获得的前 24 小时内接受 rt-PA。3 个月后溶栓患者的结果与对照组相比，使用改良的等级量表进行评估。结果 90 天的随访期后，rt-PA 组的死亡率（7.5%）略高于对照组（5%）。阿替普酶组 7.5% 的患者和 5% 的非血栓溶解患者发生 sICH；然而，这种差异并不显着。与对照组相比，rt-PA 组有更多患者（mRS = 0-2）获得良好的结果（65% vs 60%，OR 1.38，95% CI 0.50-3.6，P = 0.51）。入院时 NIHSS 评分，体重指数 (BMI) (≥ 30)，既往短暂性脑缺血发作 (TIA)/既往缺血性卒中是静脉溶栓后结果的重要预测因素。年龄、性别、高血压 (HTN)、糖尿病 (DM)、血脂异常、吸烟、心房颤动 (AF)、卒中亚型、梗塞面积和高密度大脑中动脉没有显着影响。结论 3 个月的随访后，与对照组相比，rt-PA 在增加 sICH 和死亡风险的有利结果方面没有显着增加。基线 NIHSS、BMI 和 TIA 病史或既往缺血性卒中是溶栓后结果的重要预测因素。而高密度大脑中动脉则无显着影响。结论 3 个月的随访后，与对照组相比，rt-PA 在增加 sICH 和死亡风险的有利结果方面没有显着增加。基线 NIHSS、BMI 和 TIA 病史或既往缺血性卒中是溶栓后结果的重要预测因素。而高密度大脑中动脉则无显着影响。结论 3 个月的随访后，与对照组相比，rt-PA 在增加 sICH 和死亡风险的有利结果方面没有显着增加。基线 NIHSS、BMI 和 TIA 病史或既往缺血性卒中史是溶栓后结果的重要预测因子。