脑白质疏松程度与急性脑梗死患者静脉溶栓治疗后症状性脑出血转化的相关性研究

发布时间：2018-09-01 14:07

【摘要】：目的探讨脑白质疏松(LA)程度与急性脑梗死患者静脉应用重组人组织型纤溶酶原激活剂(rt-PA)溶栓治疗后症状性脑出血(sICH)转化的相关性。方法连续选取急性颈内动脉系统脑梗死患者117例,符合溶栓治疗指征者采用静脉rt-PA以0.9 mg/kg足量溶栓治疗,其余则给予普通安慰剂治疗。所有患者根据Wahlund改良LA分级量表(ARWMC)评分对LA严重程度进行分级:轻度(1~5分),中度(6~10分),重度(10分)。溶栓后24~36 h复查头CT,判定是否出现sICH转化。比较不同程度LA患者中溶栓组和安慰剂组sICH转化率。结果本研究组中,溶栓治疗者49例,安慰剂使用者68例;LA轻度45例,LA中度25例,LA重度47例。本研究共有10例患者(8.5%)发生s ICH转化,其中溶栓治疗者7例,安慰剂使用者3例;LA轻度2例,LA中度2例,LA重度6例。在LA轻度及中度患者中,溶栓组患者sICH转化率略高于较安慰剂组(P=0.052,P=0.650)。而在LA重度患者中,溶栓组患者s ICH转化率明显高于安慰剂组(P=0.043)。Pearson相关性分析结果显示,溶栓组患者ARWMC评分与其静脉溶栓治疗后sICH转化率呈正相关(r=0.476,P=0.0005)。结论重度LA可增加急性脑梗死患者rt-PA静脉溶栓后sICH转化的风险。了解患者的LA程度有助于对临床溶栓决策的选择和对患者预后的判断。
[Abstract]:Objective to investigate the correlation between the degree of leukoaraiosis (LA) and the (sICH) transformation in patients with acute cerebral infarction after thrombolytic therapy with recombinant human tissue plasminogen activator (rt-PA). Methods 117 consecutive patients with acute cerebral infarction of internal carotid artery system were selected. The patients who were in accordance with thrombolytic therapy indications were treated with intravenous rt-PA with 0.9 mg/kg adequate thrombolytic therapy and the others were treated with general placebo. The severity of LA was graded according to the (ARWMC) score of Wahlund modified LA scale: mild (1 ~ 5), moderate (6 ~ 10), severe (10). After 24 minutes of thrombolytic therapy, the head CT, was reviewed to determine whether there was sICH transformation or not. SICH conversion rates were compared between thrombolytic group and placebo group in patients with different degrees of LA. Results in this study group, 49 patients were treated with thrombolytic therapy, and 47 patients were treated with placebo as placebo group, with mild LA in 45 cases, moderate LA in 25 cases and severe LA in 47 cases. In this study, 10 patients (8.5%) developed s ICH transformation, including 7 patients with thrombolytic therapy and 3 patients with placebo who had mild LA in 2 patients and moderate LA in 2 patients and severe LA in 6 patients. In mild and moderate LA patients, the sICH conversion rate in thrombolytic group was slightly higher than that in placebo group (P0. 052, P0. 650). In severe patients with LA, the conversion rate of s ICH in thrombolytic group was significantly higher than that in placebo group (P0. 043). Pearson correlation analysis showed that the ARWMC score of thrombolytic group was positively correlated with sICH conversion rate after intravenous thrombolytic therapy (r = 0. 476, P < 0. 0005). Conclusion severe LA can increase the risk of sICH transformation after rt-PA intravenous thrombolysis in patients with acute cerebral infarction. Understanding the degree of LA is helpful to the choice of clinical thrombolytic decision and to the prognosis of patients.
【作者单位】：大连市第三人民医院神经内科;大连市中心医院神经内科;
【基金】：大连市局卫生计生机构医学科研课题(2013-34)
【分类号】：R743.3

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