|
尿激酶超时间窗静脉治疗急性脑梗死的研究进展
|
Abstract:
急性脑梗死是脑血管病变引起的疾病,具有较高的致死致残率,且发病人数逐年增多,造成了沉重的负担,静脉溶栓是经循证医学认证的有效实现再灌注的措施,但传统的治疗时间窗较窄,只有少数患者符合标准。多模式磁共振可帮助筛选存在缺血半暗带的超时间窗患者,使其从静脉溶栓中获益,本文针对国内外对尿激酶治疗超时间窗急性脑梗死的研究进展进行综述。
Acute cerebral infarction is a disease which is caused by cerebrovascular disturbs. It has a high rate of death and disability. The number of patients is increasing year by year and causing a heavy load. Intravenous thrombolysis is an effective reperfusion measure that is certified by evidence based medicine, but the traditional treatment time window is narrow, and only a few patients meet the standards. Multimode MRI can help to select patient who is beyond therapeutic window but has is-chemic penumbra, and make them get benefit from intravenous thrombolysis. This article reviews the research progress of Urokinase in the treatment of acute cerebral infarction in the ultra-time window.
[1] | GBD 2019 Stroke Collaborators (2021) Global, Regional, and National Burden of Stroke and Its Risk Factors, 1990-2019: A Systematic Analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20, 795-820.
https://doi.org/10.1016/S1474-4422(21)00252-0 |
[2] | 彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018 [J]. 中华神经科杂志, 2018, 51(9): 666-682. |
[3] | Aguiar de Sousa D., von Martial, R., Abilleira, S., et al. (2019) Access to and Delivery of Acute Ischaemic Stroke Treatments: A Survey of National Scientific Societies and Stroke Experts in 44 European Countries. European Stroke Journal, 4, 13-28. https://doi.org/10.1177/2396987318786023 |
[4] | Astrup, J., Siesj?, B.K. and Symon, L. (1981) Thresholds in Cerebral Ischemia—The Ischemic Penumbra. Stroke, 12, 723-725. https://doi.org/10.1161/01.STR.12.6.723 |
[5] | Baron, J.C., von Kummer, R. and del Zoppo, G.J. (1995) Treatment of Acute Ischemic Stroke. Challenging the Concept of a Rigid and Universal Time Window. Stroke, 26, 2219-2221. https://doi.org/10.1161/01.STR.26.12.2219 |
[6] | Kawano, H., Bivard, A., Lin, L., et al. (2017) Perfusion Computed Tomography in Patients with Stroke Thrombolysis. Brain, 140, 684-691. |
[7] | Campbell, B.C.V., Ma, H., Ringleb, P.A., et al. (2019) Extending Thrombolysis to 4?5-9 h and Wake-Up Stroke Using Perfusion Imaging: A Systematic Review and Meta-Analysis of Individual Patient Data. The Lancet, 394, 139-147. (Published Correction Appears in The Lancet, 2020 Jun 20, 395(10241): 1906)
https://doi.org/10.1016/S0140-6736(19)31053-0 |
[8] | 江天丽, 马烈, 傅新民, 等. 常规时间窗与扩大时间窗动、静脉联合溶栓治疗急性脑梗死临床疗效的对比研究[J]. 实用心脑肺血管病杂志, 2017, 25(3): 65-68. |
[9] | 张书婷, 周俊山. 急性缺血性卒中患者侧支循环的评估及临床意义[J]. 中华神经科杂志, 2018, 51(1): 62-66. |
[10] | Vagal, A., Aviv, R., Sucharew, H., et al. (2018) Collateral Clock Is More Important Than Time Clock for Tissue Fate. Stroke, 49, 2102-2107. https://doi.org/10.1161/STROKEAHA.118.021484 |
[11] | Sun, F., Liu, H., Fu, H.X., et al. (2020) Comparative Study of Intravenous Thrombolysis with rt-PA and Urokinase for Patients with Acute Cerebral Infarction. Journal of International Medical Research, 48.
https://doi.org/10.1177/0300060519895352 |
[12] | 荣华, 王根辈, 李剑, 等. 单链尿激酶型纤溶酶原激活剂作用机制与临床应用的研究现状[J]. 中国临床药理学杂志, 2021, 37(18): 2527-2529, 2534. |
[13] | Kadir, R.R.A. and Bayraktutan, U. (2020) Urokinase Plasminogen Activator: A Potential Thrombolytic Agent for Ischaemic Stroke. Cellu-lar and Molecular Neurobiology, 40, 347-355. https://doi.org/10.1007/s10571-019-00737-w |
[14] | Powers, W.J. (2020) Acute Ischemic Stroke. The New England Journal of Medicine, 383, 252-260.
https://doi.org/10.1056/NEJMcp1917030 |
[15] | Albers, G.W., Marks, M.P., Kemp, S., et al. (2018) Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. The New England Journal of Medicine, 378, 708-718. https://doi.org/10.1056/NEJMoa1713973 |
[16] | Nogueira, R.G., Jadhav, A.P., Haussen, D.C., et al. (2018) Throm-bectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. The New England Journal of Medicine, 378, 11-21.
https://doi.org/10.1056/NEJMoa1706442 |
[17] | Kharel, S., Nepal, G., Joshi, P.R., Yadav, J.K. and Shrestha, T.M. (2022) Safety and Efficacy of Low-Cost Alternative Urokinase in Acute Ischemic Stroke: A Systematic Review and Me-ta-Analysis. Journal of Clinical Neuroscience, 106, 103-109. https://doi.org/10.1016/j.jocn.2022.09.015 |
[18] | 张彧青. 不同剂量尿激酶溶栓超早期治疗对急性脑梗死患者临床疗效及影响因素分析[D]: [硕士学位论文]. 天津: 天津医科大学, 2014. |
[19] | Zhang, R., Wei, H., Ren, Y., et al. (2021) Outcomes and Treatment Complications of Intrave-nous Urokinase Thrombolysis in Acute Ischemic Stroke in China. Frontiers in Neurology, 12, Article 685454.
https://doi.org/10.3389/fneur.2021.685454 |
[20] | 祝胜利. 不同剂量尿激酶静脉溶栓治疗脑梗死临床疗效比较[J]. 基层医学论坛, 2018, 22(20): 2809-2810. |
[21] | 张宁, 王振华, 王宽红. 不同剂量尿激酶静脉溶栓治疗对急性脑梗死的效果及安全性观察[J]. 中国实用医刊, 2015, 42(23): 25-26. |
[22] | 张永顺, 温倩茹, 陈文勇. 小剂量尿激酶与双联抗血小板聚集治疗超溶栓时间窗急性轻型脑梗死患者疗效观察[J]. 云南医药, 2022, 43(1): 43-46. |
[23] | 李文武. 急性脑梗死TOAST分型尿激酶静脉溶栓治疗198例临床疗效分析[J]. 大理大学学报, 2017, 2(4): 41-45. |
[24] | 凌佳龙, 骆少明. 磁共振DWI和FLAIR序列在早期诊断急性脑梗塞中的应用价值研究[J]. 中国CT和MRI杂志, 2018, 16(1): 19-21. |
[25] | Madai, V.I., Galinovic, I., Grittner, U., et al. (2014) DWI Intensity Values Pre-dict FLAIR Lesions in Acute Ischemic Stroke. PLOS ONE, 9, e92295. https://doi.org/10.1371/journal.pone.0092295 |
[26] | 冯莉莉, 麻增林, 田晞, 等. 磁共振弥散加权成像对超急性期脑梗死诊断价值的Meta分析[J]. 医学综述, 2014, 20(17): 3209-3212. |
[27] | Nagaraja, N. (2021) Diffusion Weighted Imaging in Acute Ischemic Stroke: A Review of Its Interpretation Pitfalls and Advanced Diffusion Imaging Application. Journal of the Neurological Sciences, 425, Article ID: 117435.
https://doi.org/10.1016/j.jns.2021.117435 |
[28] | Ma, L., Gao, P.Y., Hu, Q.M., et al. (2010) Prediction of Infarct Core and Salvageable Ischemic Tissue Volumes by Analyzing Apparent Diffusion Coefficient without Intravenous Con-trast Material. Academic Radiology, 17, 1506-1517.
https://doi.org/10.1016/j.acra.2010.07.010 |
[29] | 张茹, 朱政锜, 朱丽, 等. 基于ADC图的影像组学模型在判断急性缺血性脑卒中缺血半暗带的价值[J]. 中华放射学杂志, 2021, 55(4): 383-389. |
[30] | 秦元林, 于昊, 陈月芹. 多模态MRI对急性缺血性脑卒中诊断及预后评估的研究进展[J]. 磁共振成像, 2022, 13(8): 112-116. |
[31] | 温阿明, 王培军, 杨学东, 等. 多模式磁共振在指导小范围急性脑卒中静脉溶栓治疗中的应用价值[J]. 海军医学杂志, 2016, 37(1): 36-39. |
[32] | Cheung, J., Doerr, M., Hu, R. and Sun, P.Z. (2021) Refined Ischemic Penumbra Imaging with Tissue pH and Diffusion Kurtosis Magnetic Resonance Imaging. Translational Stroke Research, 12, 742-753.
https://doi.org/10.1007/s12975-020-00868-z |
[33] | 王泽堃, 朱珏华, 方琪. 超时间窗急性缺血性脑卒中再灌注治疗的研究进展[J]. 中华神经科杂志, 2022, 55(9): 1045-1054. |
[34] | 张艳波, 宋志成, 史丽杰. 多模态MR在急性缺血性脑卒中的应用研究[J]. 中国CT和MRI杂志, 2020, 18(5): 66-68, 78. |
[35] | 韩小辉, 姜广亚, 黄玮, 等. 多模式MRI辅助静脉溶栓治疗急性前循环缺血性脑卒中疗效及对hs-CRP的影响[J]. 中西医结合心脑血管病杂志, 2017, 15(18): 2321-2325. |
[36] | Ma, H., Campbell, B.C.V., Parsons, M.W., et al. (2019) Thrombolysis Guided by Per-fusion Imaging up to 9 Hours after Onset of Stroke. The New England Journal of Medicine, 380, 1795-1803. (Published Correction Appears in The New England Journal of Medicine, 2021 Apr 1, 384(13): 1278) https://doi.org/10.1056/NEJMoa1813046 |
[37] | Zhang, J., Ta, N., Fu, M., et al. (2022) Use of DWI-FLAIR Mis-match to Estimate the Onset Time in Wake-Up Strokes. Neuropsychiatric Disease and Treatment, 18, 355-361. https://doi.org/10.2147/NDT.S351943 |
[38] | 尹刘杰, 赵松耀, 王洪科, 等. 多模MRI在急性缺血性脑卒中患者诊治中的应用[J]. 中国CT和MRI杂志, 2019, 17(3): 50-52. https://doi.org/10.3969/j.issn.1672-5131.2019.03.016 |
[39] | Cheng, B., Pinnschmidt, H., K?nigsberg, A., et al. (2022) Estimating Nocturnal Stroke Onset Times by Magnetic Resonance Imaging in the WAKE-UP Trial. International Journal of Stroke, 17, 323-330.
https://doi.org/10.1177/17474930211059608 |
[40] | Aoki, J., Kimura, K., Iguchi, Y., Shibazaki, K., Sakai, K. and Iwanaga, T. (2010) FLAIR Can Estimate the Onset Time in Acute Ischemic Stroke Patients. Journal of the Neurological Sciences, 293, 39-44.
https://doi.org/10.1016/j.jns.2010.03.011 |
[41] | Schwamm, L.H., Wu, O., Song, S.S., et al. (2018) Intravenous Thrombolysis in Unwitnessed Stroke Onset: MR WITNESS Trial Results. Annals of Neurology, 83, 980-993. https://doi.org/10.1002/ana.25235 |
[42] | Thomalla, G., Simonsen, C.Z., Boutitie, F., et al. (2018) MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. The New England Journal of Medicine, 379, 611-622. https://doi.org/10.1056/NEJMoa1804355 |
[43] | Legrand, L., Turc, G., Edjlali, M., et al. (2019) Benefit from Revas-cularization after Thrombectomy According to FLAIR Vascular Hyperintensities-DWI Mismatch. European Radiology, 29, 5567-5576.
https://doi.org/10.1007/s00330-019-06094-y |
[44] | Zeng, L., Chen, J., Liao, H., Wang, Q., Xie, M. and Wu, W. (2021) Fluid-Attenuated Inversion Recovery Vascular Hyperintensity in Cerebrovascular Disease: A Review for Radiol-ogists and Clinicians. Frontiers in Aging Neuroscience, 13, Article 790626. https://doi.org/10.3389/fnagi.2021.790626 |