药物溶栓治疗卒中新进展

Many more stroke patients could benefit from thrombolytic treatment (the use of drugs to break up or dissolve blood clots), but it needs to be administered as quickly as possible after the first signs of illness, according to new findings from the largest meta-analysis to date investigating the clot-busting drug alteplase. The study, which involved more than 6700 stroke patients, published in Lancet.
        有关阿替普酶用于卒中溶栓治疗的研究获得新发现。据《柳叶刀》杂志发表的一份纳入超过6700名卒中患者、迄今最大规模的meta分析结果表明，更多患者可能从溶栓治疗中获益(使用溶栓药物)，但需在发病后尽快给药。
        The emergency treatment with alteplase markedly improves the chances of a good outcome when administered within 4·5 hours of onset of symptoms but, although still worthwhile, its benefit diminishes the later it is given.
        应用阿替普酶在发病后4-5小时内紧急给药显著提高了改善预后的机率，尽管该时段后仍值得给药治疗，但疗效降低。
        The findings show just how important it is for people with acute ischaemic stroke (in which blood flow to an area of the brain is blocked or reduced) to be identified quickly and treated by specialist staff in order to reduce the subsequent degree of disability.
        该结果显示，为减轻远期预后的病残程度，对急性缺血性卒中患者(流向脑部血流阻滞或减少)的快速诊断和专业化治疗极其重要。
        “Our results show that alteplase treatment is a very effective means of limiting the degree of disability in stroke patients”*, said study co-author and senior statistician Dr Jonathan Emberson, from the Clinical Trial Service Unit at the University of Oxford in the UK.
        本项研究的共同作者及高级统计师、来自英国牛津大学临床试验服务中心的乔纳森·艾伯森博士表示，“我们的研究结果表明，应用阿替普酶治疗是减少卒中患者病残程度的有效方法。
        Dr Emberson and colleagues conducted a meta-analysis of individual patient data from all the major trials of alteplase for treatment of acute ischaemic stroke. Analysis of data from nine randomised trials involving 6756 patients (1729 older than 80 years of age) showed that alteplase treatment significantly increased the odds of a good stroke outcome (no significant disability 3–6 months after stroke), with faster treatment offering the best chance of recovery.
        艾伯森博士及其同事们从阿替普酶治疗急性缺血性卒中的所有主要试验中，对个体患者数据进行了荟萃分析。该项研究纳入6756例患者(其中1729名患者年龄超过80岁)的9项随机试验数据，结果显示，阿替普酶疗法显著增加了卒中预后良好的机率(卒中发病3-6月后患者无明显残疾)，治疗越早，获得最佳康复的机会越大。
        The odds of a good stroke outcome were 75% greater for patients given alteplase within 3 hours of initial stroke symptoms, compared with those who did not receive the drug; for those given the drug between 3 and 4·5 hours post-stroke there was a 26% increased chance of a good outcome; while for those with a delay of more than 4·5 hours in receiving treatment, there was just a 15%, not statistically significant, increase in the chance of a good recovery.
        对于卒中发病3小时内给予阿替普酶治疗的患者，其卒中预后良好的机率比未给药者高75%;在卒中后3-4.5小时给药，预后良好的机率增加26%;而延迟至发病后4.5小时以上给药治疗，该机率仅增加15%，没有统计学意义。
        According to Dr Emberson, “Although alteplase increased the risk of death from intracranial haemorrhage by about 2% within the first few days after stroke, by a few months survivors treated with alteplase were less likely to be disabled than those not receiving such treatment. Indeed, alteplase increased the proportion who avoided disability altogether by about 10% for patients treated within 3 hours and 5% for those treated between 3 and 4·5 hours.”
        据艾伯森博士的说法，“尽管阿替普酶增加了卒中患者发病最初几天内的颅内出血死亡风险(约为2%)，但对幸存患者经过数月阿替普酶治疗后，他们比未接受本疗法患者更不易出现残疾症状。事实上，对于在发病后3小时内和3-4.5小时之间接受治疗的患者，阿替普酶分别将致残率降低了约10%和5%。
        According to Kennedy Lees, study co-author and Professor of Cerebrovascular Medicine at the University of Glasgow, UK, “What this shows is that we are up against the clock when treating ischaemic stroke. Every minute counts. People need to be identified quickly and systems need to be in place to get them scanned, diagnosed accurately, and then treated within minutes to hours.”
        据英国格拉斯哥大学脑血管病学教授、本项研究的共同作者肯尼迪·利兹所述，“该研究显示，我们在治疗缺血性卒中方面须分秒必争。需要对患者快速识别、获取扫描影像和精确诊断，并在数分钟至数小时内给予治疗。”
        Importantly, the benefits of alteplase were observed in all patient groups studied, including those aged 80 or over and those with severe strokes. Richard Lindley, Professor of Geriatric Medicine at the University of Sydney, and a study co-author added, “These results demonstrate that upper age limits in clinical trials can inadvertently lead to the elderly being excluded from an effective treatment. These new results tell us that the elderly should be treated with the same urgency as younger patients.”
        重要的是，在所有受试者组中均可观察到阿替普酶的疗效，包括80岁及以上高龄患者和严重卒中患者。本项研究的共同作者、悉尼大学老年医学教授理查德·林德利补充道，“这些结果表明，临床试验的年龄上限要求可能在不经意间导致高龄患者错失有效治疗。这些新的研究结果告诉我们，对高龄患者的治疗应当象对待年轻患者一样紧迫。”
        Study co-author Peter Sandercock, Professor of Neurology, University of Edinburgh said, “I cannot over-emphasise how useful these analyses are—they provide the type of clear information that patients and their families need when weighing the benefits and risks of this important treatment.”*
        本文共同作者、爱丁堡大学神经病学教授Peter Sandercock说，“我不能过分强调这些分析的重要性—他们为患者和家人在权衡这些重要治疗的风险收益时提供了明确信息。”
        Writing in a linked Comment, Michael Hill and Shelagh Coutts from the Hotchkiss Brain Institute and Department of Clinical Neurosciences, Calgary, Canada, point out that, “The data render obsolete the European licensing label for alteplase—which excludes patients older than 80 years and those with severe stroke. The finding of a small benefit of treatment up to 4·5 h from onset makes the advice of the US Food and Drug Administration and Health Canada to not treat patients after 3 h from onset similarly outdated.”
        在随后评论中，加拿大卡尔加里Hotchkiss脑研究所和临床神经科学部的Michael Hill和Shelagh Coutts指出，“该数据致使阿替普酶在欧洲的说明书过时—它排除了大于80岁的高龄患者及严重卒中患者。该研究发现直到发病4-5小时给药仍有轻度治疗获益，这使原来认为发病超过3小时不予治疗的美国FDA和加拿大卫生部的建议同样过时。”
        They add, “The question now is not whether we can extend the window for treatment. Rather, how do we get everyone treated faster and how do we dispel preconceived notions about not treating older patients or those with milder strokes?…Auditsshow that patients with ischaemic stroke are offered thrombolysis too rarely or, if they are offered it, too slowly. Quick treatment requires efficient processes and a team approach. Pre-hospital systems to identify patients and bring them to the appropriate hospitals, emergency department swarming, rapid simple imaging, and use of telemedicine must be harnessed to reduce times to treatment. Strategies to do so will vary by region but it is simply unacceptable not to achieve very fast treatment times.”
        他们补充道，“目前存在的问题并非是能否扩展治疗窗，而是如何使每名患者都尽快得到治疗，并且，对于未经治疗的老年或轻型患者如何消除既有观念。调查表明，很少为缺血性卒中患者提供溶栓治疗，或即使提供也为之过晚。快速治疗需要一个有效流程和协作途径：包括院前体系以识别患者、转运到合适医院、急诊部分诊、快速简便影像、远程医疗应用等，必须充分利用这些以缩短治疗前时间。可根据不同区域采用不同策略，以务必达到快速治疗的目标。

学习了，很棒。

学习了。

给这位药师点一个赞！对药物治疗进展的中英文展示让我们这些看过半百的老药师既学了新知识、又温习了专业英语。希望今后坛里多一些这样的好文！

赞一个，翻译水平很好。