轻型卒中：溶栓还是不溶栓？ Thrombolysis or Not Thrombolysis for Minor Stroke?

Abstract

轻型卒中的定义及诊断标准尚不统一，其是否都需要溶栓尚存在争议。轻型卒中在我国卒中患者中的比例有逐年增加的趋势，虽然有基于氯吡格雷用于急性非致残性脑血管病事件高危人群（clopidogrel in high-risk patients with acute non-disabling cerebrovascular events，CHANCE）系列研究抗血小板治疗的循证医学证据，但仍有30%的患者预后不良，由此带来的疾病负担仍然很重。当前指南对于发病4.5 h内的轻型致残性卒中推荐静脉溶栓治疗，而对于轻型非致残性卒中意见不一。近年的研究显示，对于轻型卒中合并大血管闭塞患者，早期包括静脉溶栓在内的积极再灌注治疗可能会给患者带来功能获益。本文对轻型卒中溶栓相关研究进行综述，期待未来有更多的设计严谨的大型试验来评估溶栓治疗在轻型卒中患者中的有效性和安全性。 Abstract: The definition and diagnostic criteria of minor stroke are not unified until now, and it is still controversial whether all patients with acute minor stroke need intravenous thrombolysis. The proportion of minor stroke patients in China has an increasing trend year by year. Although the CHANCE (clopidogrel in high-risk patients with acute non-disabling cerebrovascular events) trial and other studies have showed that antiplatelet therapy is effective for minor stroke, there are still approximately 30% of patients with poor functional outcomes and the burden of disease is very heavy. The current guidelines recommended intravenous alteplase administration within 4.5 hours for patients with disabling minor stroke but not for nondisabling minor stroke. Recent studies showed that reperfusion therapy including intravenous thrombolysis might be beneficial for patients with minor stroke and large vessel occlusion. This article reviewed the advances in thrombolytic therapy for minor stroke, to provide reference for clinical treatment and relevant research in minor stroke.

Keywords

• 轻型卒中
• 溶栓治疗
• 阿替普酶
• 替奈普酶
• 预后
• minor stroke
• thrombolytic therapy
• alteplase
• tenecteplase
• prognosis