Je clinical‑ diffusion mismatch sdružen s dobrým klinickým výsledkem u pacientů s akutním ischemickým iktem léčených intravenózní trombolýzou?

English version

Authors: D. Šaňák ¹; D. Horák ²; M. Král ¹; R. Herzig ¹; J. Zapletalová ³; D. Školoudík ¹; T. Veverka ¹; A. Bártková ¹; I. Vlachová ¹; S. Buřval ²; M. Heřman ²; P. Kaňovský ¹
Authors‘ workplace: Iktové centrum, Neurologická klinika LF UP a FN Olomouc ¹; Radiologická klinika LF UP a FN Olomouc ²; Ústav biometrie a statistiky, LF UP v Olomouci ³
Published in: Cesk Slov Neurol N 2009; 72/105(6): 548-552
Category: Original Paper

Overview

Východiska a cíle:

Mismatch (nesoulad) mezi tíží ischemického iktu (IS) kvantifikovanou pomocí škály National Institutes of Health Stroke Scale (NIHSS) a objemem infarktového ložiska na MRI- DWI (Clinical- Diffusion Mismatch; CDM) může predikovat následnou progresi velikosti infarktu a neurologického deficitu. Cílem práce bylo srovnat progresi ischemických změn, klinický stav a incidenci symptomatického krvácení (sICH) u pacientů s akutním iktem, kteří měli/ neměli CDM a současně byli léčeni intravenózní trombolýzou (IVT) do 3 hod od vzniku iktu.

Soubor a metodika:

Retrospektivně bylo analyzováno celkem 125 konsekutivních pacientů s hemisferálním ischemickým iktem (78 mužů, průměrný věk 66,0 ± 12,1 let). CDM byl definován jako NIHSS ≥ 8 a DWI objem ≤ 25 ml, non‑mismatch jako NIHSS ≥ 8 a DWI objem > 25 ml. Objem infarktu byl kvantifikován při přijetí a po 24 hod. Neurologický deficit byl hodnocen pomocí škály NIHSS při přijetí a po 24 hod, a 90denní klinický výsledek pomocí modifikované Rankin Scale (mRS). Ke statistickému zhodnocení výsledků byly použity Mann‑Whitney, Fischer Exact a χ2 test a dále vícestupňová lineární regresní analýza.

Výsledky:
CDM byl přítomen u 61 (48,8 %) pacientů a nepřítomen u 31 (26,4 %). Pacienti bez mismatche měli signifikantně větší progresi infarktových změn (p < 0,0001) po 24 hod. CDM pacienti měli významně větší pokles ve škále NIHSS po 24 hod (p = 0,005) a lepší 90denní klinický výsledek (medián mRS: 1) oproti pacientům bez mismatche (medián mRS: 5, p < 0,0001). Pacienti bez mismatche měli vyšší incidenci sICH (16,1 vs 0 %, p = 0,003) a mortalitu po IVT (15,8 vs 0 %, p = 0,0001).

Závěr:
Pacienti s CDM před IVT měli významně lepší klinický výsledek oproti pacientům bez mismatche.

Klíčová slova:
ischemic stroke – intravenous thrombolysis – magnetic resonance imaging

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