nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2013-2337nnp-251Research ArticleArticlesСтатьиAnalysis of factors influencing the early efficiency of systemic thrombolytic therapy for ischemic strokeАнализ факторов, влияющих на раннюю эффективность тромболитической терапии при ишемическом инсультеPrazdnichkovaElena VladimirovnaPrazdnichkovaElena Vladimirovnaprazdnichkova@yandex.ruAlasheevA MAlasheevA Mprazdnichkova@yandex.ruShalaginaO AShalaginaO Aprazdnichkova@yandex.ruVolkovaL IVolkovaL Iprazdnichkova@yandex.ruГБУЗ СО «Свердловская областная клиническая больница № 1», ЕкатеринбургРоссияSverdlovsk Regional Clinical Hospital One, YekaterinburgRussian FederationГБУЗ СО «Демидовская больница г. Нижний Тагил»РоссияDemidov Hospital, Nizhny TagilRussian FederationГБОУ ВПО «Уральская государственная медицинская академия» Минздрава России, ЕкатеринбургРоссияUral State Medical Academy, Ministry of Health of Russia, YekaterinburgRussian Federation20130711201353NO3 (2013)3235Copyright © Prazdnichkova E.V., Alasheev A.M., Shalagina O.A., Volkova L.I., 20132013Prazdnichkova E.V., Alasheev A.M., Shalagina O.A., Volkova L.I.Prazdnichkova E.V., Alasheev A.M., Shalagina O.A., Volkova L.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/251

he paper shows the urgency of enhancing the efficiency of systemic thrombolytic therapy (TLT).Objective: to study the impact of age, gender, smoking, atrial fibrillation, glucose levels at admission and the time of initiation of TLT after ischemic stroke onset on its early efficiency. Patients and methods. The efficiency of TLT was analyzed in 44 patients with ischemic stroke. Their mean age was 59.5 (range 53.0–70.0) years; 43.2% were smokers; persistent and paroxysmal atrial fibrillation was seen in 27 and 7% of the patients, respectively. The interval between the onset of the disease onset and thrombolysis averaged 187.5 (range 152.5–217.5) min. The criterion for the early efficiency of TLT was a ≥4 score reduction in the severity of neurological deficit according to the National Institute of Health Stroke Scale (NIHSS) on day 7. The mean NIHSS score at admission was 11.5 (range 9–16.5%). Neurological deficit at hospital admission was higher in patients with cardioembolic stroke – 14.0 (range 12.0–18.0) scores.Results. Improvement was observed in 66% of the patients on day 7. The mean NIHSS score on day 7 was 6.0 (range 4–12). There was a significant correlation between the high early efficiency of TLT, time to start thrombolysis, and baseline blood glucose level. The influence of other factors calls for further investigations in a larger patient sample.

В статье указано на актуальность повышения эффективности системной тромболитической терапии (ТЛТ).Цель исследования – изучить влияние возраста, пола, курения, наличия фибрилляции предсердий, уровня глюкозы при поступлении и времени начала ТЛТ после развития ишемического инсульта на ее раннюю эффективность. Пациенты и методы. Проанализирована эффективность ТЛТ у 44 пациентов с ишемическим инсультом. Средний возраст пациентов – 59,5 (53,0–70,0) года, 43,2% больных – курильщики, у 27% – постоянная, у 7% – пароксизмальная форма фибрилляции предсердий. Время от начала заболевания до проведения тромболизиса составило в среднем 187,5 (152,5–217,5) мин. Критерием ранней эффективности ТЛТ служило уменьшение тяжести неврологического дефицита по шкале инсульта Национального института здоровья США (NIHSS) на ≥4 балла на 7-е сутки. Средний балл по NIHSS на момент поступления – 11,5 (9–16,5). Неврологический дефицит при поступлении был выше у пациентов с кардиоэмболическим инсультом – 14,0 (12,0–18,0) баллов. Результаты исследования. Улучшение на 7-е сутки наблюдалось у 66% пациентов. Средний балл по NIHSS на 7-е сутки – 6,0 (4–12). Выявлена достоверная корреляция между высокой ранней эффективностью ТЛТ, временем до начала тромболизиса и исходным уровнем глюкозы в крови. Влияние других факторов требует дальнейшего исследования на большей выборке пациентов.

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DOI: 10.1016%2Fj.jacc.2004.10.018.</p><p>Purcell IF, Newall N, Farrer M. Lower cardiac mortality in smokers following thrombolysis for acute myocardial infarction may be related to more effective fibrinolysis. QJM. 1999;92(6):327–33. DOI: 10.1093%2Fqjmed%2F92.6.327.</p><p>Barbash GI, White HD, Modan M et al. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation. 1993;87(1):53–8. DOI: 10.1161%2F01.CIR.87.1.53.</p><p>Newby DE, McLeod AL, Uren NG et al. Impaired coronary tissue plasminogen activator release is associated with coronary atherosclerosis and cigarette smoking: direct link between endothelial dysfunction and atherothrombosis. Circulation. 2001;103(15):1936–41. DOI: 10.1161%2F01.CIR.103.15.1936.</p><p>Zangerle A, Kiechl S, Spiegel M et al. 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DOI: 10.1161/STROKEAHA.108.546325. Epub 2009 Apr 16.</p><p>Di Legge S, Saposnik G, Nilanont Y, Hachinski V. Neglecting the difference: does right or left matter in stroke outcome after thrombolysis? Stroke. 2006;37(8):2066–9. Epub 2006 Jun 22.</p><p>Grines CL, Topol EJ, O’Neill WW et al. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation. 1995;91(2):298–303. DOI: 10.1161%2F01.CIR.91.2.298.</p><p>Kirtane AJ, Martinezclark P, Rahman AM et al. Association of smoking with improved myocardial perfusion and the angiographic characterization of myocardial tissue perfusion after fibrinolytic therapy for ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005;45(2):321–23. DOI: 10.1016%2Fj.jacc.2004.10.018.</p><p>Purcell IF, Newall N, Farrer M. Lower cardiac mortality in smokers following thrombolysis for acute myocardial infarction may be related to more effective fibrinolysis. QJM. 1999;92(6):327–33. DOI: 10.1093%2Fqjmed%2F92.6.327.</p><p>Barbash GI, White HD, Modan M et al. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation. 1993;87(1):53–8. DOI: 10.1161%2F01.CIR.87.1.53.</p><p>Newby DE, McLeod AL, Uren NG et al. Impaired coronary tissue plasminogen activator release is associated with coronary atherosclerosis and cigarette smoking: direct link between endothelial dysfunction and atherothrombosis. Circulation. 2001;103(15):1936–41. DOI: 10.1161%2F01.CIR.103.15.1936.</p><p>Zangerle A, Kiechl S, Spiegel M et al. Recanalization after thrombolysis in stroke patients: predictors and prognostic implications. Neurology. 2007;68(1):39–44. DOI: 10.1212%2F01.wnl.0000250341.38014.d2.</p><p>Vaidyula VR, Rao AK, Mozzoli M et al. Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes. 2006;55(1):202–8. DOI: 10.2337%2Fdiabetes.55.01.06.db05-1026.</p><p>Lemkes BA, Hermanides J, Devries JH et al. Hyperglycemia: a prothrombotic factor? J ThrombHaemost. 2010;8(8):1663–9. DOI: 10.1111/j.1538-7836.2010.03910.x. Epub 2010 May 12.</p><p>Pandolfi A, Giaccari A, Cilli C et al. Acute hyperglycemia and acute hyperinsulinemia decrease plasma fibrinolytic activity and increase plasminogen activator inhibitor type 1 in the rat. Acta Diabetol. 2001;38(2):71–6. DOI: 10.1007%2Fs005920170016.</p><p>Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskiy insul't. Moskva: MIA; 2012. 288 p.]</p></div><br />

The authors declare that there are no conflicts of interest present.