Zhongguo cuzhong zazhi (Oct 2023)
2016—2022年中国急性缺血性卒中静脉溶栓趋势及阿替普酶与尿激酶静脉溶栓院内结局比较分析 Trend of Intravenous Thrombolysis and a Comparative Analysis of In-hospital Outcomes of Intravenous Thrombolysis with Alteplase or Urokinase in Acute Ischemic Stroke in China from 2016 to 2022
Abstract
目的 评估我国2016—2022年发病6 h内急性缺血性卒中患者静脉溶栓的变化趋势，并比较rt-PA与尿激酶静脉溶栓的院内临床结局差异。 方法 纳入中国卒中中心联盟（Chinese Stroke Center Alliance，CSCA）2016年1月—2022年12月登记的发病6 h内到院的急性缺血性卒中患者555 991例，计算各年份rt-PA静脉溶栓和尿激酶静脉溶栓的比例变化。采用多因素logistic回归法，以rt-PA溶栓为对照，分析尿激酶溶栓对院内脑梗死出血转化、院内死亡及出院时良好神经功能结局（mRS评分0～1分）的影响。 结果 分别有113 521例和30 950例患者进行了rt-PA和尿激酶静脉溶栓，溶栓率分别为20.42%和5.57%。从2016年至2022年，rt-PA静脉溶栓率从11.26%逐年递增至30.19%，而尿激酶静脉溶栓率则始终波动在较低水平。多因素logistic回归分析显示，与rt-PA静脉溶栓相比，尿激酶静脉溶栓患者发生脑梗死后出血转化（OR 0.740，95%CI 0.662～0.827，P＜0.01）和院内死亡的风险较低（OR 0.820，95%CI 0.764～0.881，P＜0.01），但两组患者出院时良好功能结局率无显著差异（OR 0.989，95%CI 0.951～1.028，P=0.57）。 结论 2016—2022年期间，我国发病6 h内到院的急性缺血性卒中患者rt-PA静脉溶栓率呈逐年增长趋势；尿激酶溶栓后发生脑梗死出血转化风险及院内死亡风险可能低于rt-PA静脉溶栓。 Abstract: Objective To investigate the temporal trend of intravenous thrombolysis in patients with acute ischemic stroke (AIS) who arrived within 6 hours after onset from 2016 to 2022 in China, and compare the risks of in-hospital outcomes between rt-PA and urokinase thrombolysis. Methods A total of 555 991 AIS patients who arrived within 6 hours after onset were enrolled in the Chinese Stroke Center Alliance (CSCA) from January 2016 to December 2022. The rates of rt-PA and urokinase intravenous thrombolysis in AIS patients within 6 hours after onset were calculated respectively of each year. Multivariate logistic regression was used to analyze the risks of hemorrhagic transformation, in-hospital death and good functional outcome at discharge (mRS score 0-1) of urokinase thrombolysis group compared with rt-PA group. Results 113 521 and 30 950 patients were treated with rt-PA and urokinase intravenous thrombolytic therapy respectively. The thrombolysis rates of rt-PA and urokinase were 20.42% and 5.57% respectively. From 2016 to 2022, the rt-PA intravenous thrombolysis rate increased from 11.26% to 30.19%, while the urokinase thrombolysis rate fluctuated at a low level. Multivariate logistic regression analysis showed that compared with rt-PA intravenous thrombolytic therapy, patients with urokinase intravenous thrombolytic therapy had a lower risk of hemorrhagic transformation (OR 0.740, 95%CI 0.662-0.827, P<0.01) and in-hospital death (OR 0.820, 95%CI 0.764-0.881, P<0.01). There was no significant difference in the rate of good functional outcome at discharge between the two groups (OR 0.989, 95%CI 0.951-1.028, P=0.57). Conclusions The rate of rt-PA intravenous thrombolysis in AIS patients who arrived within 6 hours after onset increased year by year from 2016 to 2022. The risk of hemorrhagic transformation and in-hospital death after urokinase thrombolysis may be lower than that of rt-PA intravenous thrombolysis.
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