儿童急性缺血性卒中溶栓资格的多中心回顾性研究
该研究回顾了2010—2019年澳大利亚三家儿童医院135例（139次）症状性儿童急性缺血性卒中，评估tPA潜在合格率。研究者提出部分小血管型AIS可能成为扩展tPA适应证的潜在方向。
要点
- 儿童AIS中仅19%符合tPA治疗条件，比例低。
- 符合tPA条件者影像可见大血管闭塞、单侧局灶性脑动脉病或颅外夹层。
- 小血管型AIS占39%，其中33%除诊断延迟外无其他排除条件。
核心结论
- 依据现行多国及2026年美国心脏协会指南，仅19%（26/139）的症状性儿童AIS在无论是否考虑诊断延迟的情况下可能符合tPA治疗条件。
- 部分小血管型AIS患儿可能为扩展tPA适用范围提供机会。
研究设计与样本
- 本研究为回顾性、多中心、观察性队列研究，病例来自韦斯特米德儿童医院、约翰·亨特儿童医院和悉尼儿童医院。
- 纳入2010年1月1日至2019年12月31日期间年龄29天至17岁的症状性AIS患儿，共135例（139次症状性AIS）。
主要发现
- 潜在符合tPA条件者急性神经影像显示大血管闭塞、单侧局灶性脑动脉病或颅外夹层。
- 26例潜在符合tPA条件者中13例（50%）未经tPA治疗即获得非残疾结局。
- 所有死亡均发生在不符合tPA条件的患者中，主要与基础疾病相关。
关键数值与推荐
- 潜在符合tPA条件定义为依据多国及2026年美国心脏协会指南评估，且不考虑诊断延迟。
- 纳入病例的中位年龄为6岁，36%为女性，73%经急诊就诊，平均随访43个月，病死率12%。
临床怎么用
- 儿童AIS溶栓决策应重点关注急性神经影像所见的大血管闭塞、单侧局灶性脑动脉病和颅外夹层。
- 对于小血管型AIS患儿，需重新评估现行tPA排除标准的合理性。
局限性
- 研究为回顾性设计，依赖病历记录评估资格。
- 样本来自三家澳大利亚儿童医院，代表性有限。
- 未报告tPA实际使用后的结局数据。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Stroke, Volume 57, Issue 10, Page 3000-3009, October 1, 2026. BACKGROUND:Thrombolysis is infrequently delivered to children with acute ischemic strokes (AIS). We explored potential eligibility for treatment with tPA (tissue-type plasminogen activator) for pediatric AIS.METHODS:This retrospective, multicenter, observational, cohort study reviewed children aged 29 days to 17 years with symptomatic AIS identified via Children’s Hospital Westmead, John Hunter Children’s Hospital, and Sydney Children’s Hospital between January 1, 2010, and December 31, 2019. Medical records were examined to evaluate eligibility for treatment with tPA based on established multinational and the 2026 American Heart Association guidelines, reasons for exclusion beyond delay to diagnosis, and long-term outcomes as pediatric modified Rankin Scale scores. We also explored additional exclusions and outcomes among children with small-vessel AIS and AIS in the context of brain tumors, who are currently excluded from tPA.RESULTS:A total of 135 patients with 139 symptomatic AIS were identified—median age, 6 years; 36% female patients; 73% presented via emergency departments; mean follow-up, 43 months; 12% deaths. Irrespective of delay to diagnosis, only 26 of 139 (19%) AIS were potentially eligible for treatment with tPA. Among patients potentially eligible for tPA, acute neuroimaging revealed large-vessel occlusions, unilateral focal cerebral arteriopathy, or extracranial dissections. Thirteen of 26 (50%) had nondisabled outcomes without tPA treatment. One hundred thirteen of 139 (81%) AIS were ineligible for treatment with tPA, irrespective of delay to diagnosis. All deaths occurred among patients excluded from tPA, predominantly related to underlying disorders. Fifty-four small-vessel AIS accounted for 39% of AIS. Eighteen (33%) had no additional ineligibilities to thrombolysis, among whom 10 had nondisabled outcomes without tPA.CONCLUSIONS:Based on current recommendations, 19% of symptomatic childhood AIS were potentially eligible for treatment with tPA, irrespective of delay to diagnosis. Selected patients with small-vessel AIS may offer an opportunity to extend the role of tPA. These observations may be relevant for optimizing pediatric stroke management strategies.
引用
- Stroke：Eligibility for Thrombolysis for Pediatric Acute Ischemic Stroke
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。