rt-PA治疗合并重度牙周炎的急性缺血性卒中患者疗效评价

Efficacy evaluation of rt-PA in the treatment of acute ischemic stroke complicated with severe periodontitis

关键词:  牙周炎  急性缺血性卒中  重组组织型纤溶酶原激活剂  静脉溶栓

Key words:  periodontitis  acute ischemic stroke  recombinant tissue plasminogen activator  intravenous thrombolysis

摘要:

[目的] 探讨重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗合并重度牙周炎的急性缺血性卒中患者的安全性及有效性。[方法] 选取合并重度牙周炎的急性缺血性卒中患者118例进行回顾性研究，其中58例患者接受溶栓治疗（溶栓组），60例患者接受常规抗血小板聚集治疗（对照组）。分析各组患者入院时、治疗后24 h及7 d的NIHSS评分，治疗后3个月的改良Rankin评分，3个月内不良事件发生情况（症状性颅内出血、非症状性颅内出血、牙龈出血、皮下出血、消化系出血、泌尿系出血）和卒中相关病死率的差异性并分析合并重度牙周炎的卒中患者静脉溶栓治疗的安全性。[结果] 溶栓组与对照组相比较，治疗24 h及7 d NIHSS评分水平明显下降（P<0.05）。3个月时远期预后溶栓组优于对照组（P<0.05），但两组之间的病死率比较无明显差异。两组患者治疗3个月内的不良事件中，溶栓组发生牙龈出血的比例明显高于对照组（P<0.05），但两组患者非症状性颅内出血、皮下出血、消化系出血的发生率无明显差异，两组患者均未出现症状性颅内出血及泌尿系出血。[结论] 尽管rt-PA静脉溶栓治疗合并重度牙周炎的急性缺血性卒中患者会增加牙龈出血，但并未使症状性颅内出血等不良事件的发生率及患者病死率增加，而且，静脉溶栓还能够明显改善此类患者的预后。

Abstract:

[Objective] To investigate the safety and efficacy of intravenous thrombolysis with recombinant tissue plasminogen activator (rt PA) in patients with acute ischemic stroke complicated with severe periodontitis. [Methods] 118 patients with acute ischemic stroke complicated with severe periodontitis were studied retrospectively. Among them, 58 patients received thrombolytic therapy (thrombolytic group) and 60 patients received routine antiplatelet aggregation therapy (control group). The NIHSS scores of patients in each group at admission, 24 hours and 7 days after treatment were analyzed. Modified Rankin score 3 months after treatment, adverse events (symptomatic intracranial hemorrhage, asymptomatic intracranial hemorrhage, gingival hemorrhage, subcutaneous hemorrhage, digestive bleeding, urinary bleeding) and stroke-related deaths within 3 months. The difference of mortality rate and the safety of intravenous thrombolytic therapy in stroke patients with severe periodontitis were analyzed. [Results] Compared with the control group, the levels of NIHSS in the thrombolytic group were significantly lower at 24 and 7 days(P<0.05). The long-term prognosis thrombolysis group was superior to the control group at 3 months(P<0.05), but there was no significant difference in mortality between the two groups. The longterm prognosis of thrombolytic group was better than that of control group at 3 months(P<0.05), but there was no significant difference in mortality between the two groups. The incidence of gingival bleeding in thrombolytic group was significantly higher than that in control group within 3 months of treatment(P<0.05), but there was no significant difference in the incidence of asymptomatic intracranial hemorrhage, subcutaneous hemorrhage and digestive bleeding between the two groups. There were no symptomatic intracranial hemorrhage and urinary bleeding in both groups. [Conclusion] Although rt-PA intravenous thrombolysis in patients with acute ischemic stroke complicated with severe periodontitis increased gingival bleeding, it did not increase the incidence of adverse events such as symptomatic intracranial hemorrhage and patient mortality, and, Intravenous thrombolysis can also significantly improve the prognosis of such patients.