急性缺血性卒中患者静脉溶栓后不同部位出血转化的危险因素及预后分析

发布时间：2018-10-04 21:09

【摘要】：目的:比较急性缺血性卒中患者静脉溶栓后发生不同部位出血转化的危险因素及溶栓后患者神经功能结局的差异,分析深部出血转化与非深部出血转化的独立预测因素,并了解不同梗死部位出血转化对急性缺血性卒中患者静脉溶栓后神经功能结局的影响。方法:回顾性分析2009年6月至2013年5月浙江大学医学院附属第二医院接受静脉溶栓治疗的急性缺血性卒中患者的临床及影像学资料。按照无出血转化、深部出血转化和非深部出血转化分成三组进行基线特征及神经功能结局的比较。三组间连续变量的比较用单因素方差分析,分类变量的比较用多组卡方检验,并用logistic回归分析各部位出血转化的影响因素及其对预后的影响。结果:292例患者纳入分析,82例(28.1%)发生出血转化,其中深部出血47例(57.3%)、脑实质血肿型19例(6.5%)、出血性脑梗死型63例(21.6%);症状性出血8例(2.7%)。三组患者的年龄、基线NIHSS评分、收缩压以及心房颤动发生率差异有统计学意义(均P0.05)。校正后发现基线NIHSS评分(OR=1.126,95%CI:1.063~1.193,P0.001)和收缩压(OR=0.982,95%CI:0.967~0.998,P=0.025)是深部出血转化的独立影响因素。未发现非深部出血转化的独立危险因素。多因素分析显示,深部出血转化是影响溶栓后3个月神经功能结局的独立危险因素(OR=0.291,95%CI:0.133~0.640,P=0.002)。结论:基线神经功能缺损程度及收缩压是预测急性缺血性卒中患者溶栓后发生深部出血转化的独立危险因素,且深部出血转化提示患者静脉溶栓治疗后神经功能结局不良。
[Abstract]:Objective: to compare the risk factors of hemorrhage transformation in different sites after intravenous thrombolysis in patients with acute ischemic stroke and the difference of neurological outcomes in patients with thrombolytic therapy, and to analyze the independent predictors of deep hemorrhage transformation and non-deep hemorrhage transformation. To investigate the effect of hemorrhage transformation at different infarct sites on the outcome of nerve function after intravenous thrombolysis in patients with acute ischemic stroke. Methods: the clinical and imaging data of patients with acute ischemic stroke received intravenous thrombolytic therapy in the second affiliated Hospital of Zhejiang University Medical College from June 2009 to May 2013 were retrospectively analyzed. According to no hemorrhage transformation, deep hemorrhage transformation and non-deep hemorrhage transformation, the baseline features and neurological outcomes were compared among three groups. Single factor analysis of variance (ANOVA) was used to compare the continuous variables among the three groups, and multi-group chi-square test was used to compare the classified variables. Logistic regression analysis was used to analyze the influencing factors of bleeding transformation and its influence on prognosis. Results among 292 cases, 82 cases (28.1%) had hemorrhage transformation, including 47 cases of deep hemorrhage (57.3%), 19 cases of cerebral parenchymal hematoma type (6.5%), 63 cases of hemorrhagic cerebral infarction type (21.6%) and 8 cases of symptomatic hemorrhage (2.7%). There were significant differences in age, baseline NIHSS score, systolic blood pressure and incidence of atrial fibrillation among the three groups (P0.05). After correction, baseline NIHSS score (OR=1.126,95%CI:1.063~1.193,P0.001) and systolic blood pressure (OR=0.982,95%CI:0.967~0.998,P=0.025) were found to be independent factors of deep hemorrhage transformation. No independent risk factors for non-deep hemorrhage transformation were found. Multivariate analysis showed that deep hemorrhage transformation was an independent risk factor (OR=0.291,95%CI:0.133~0.640,P=0.002) for neurological outcomes 3 months after thrombolysis. Conclusion: the degree of baseline nerve function defect and systolic blood pressure are independent risk factors for predicting deep hemorrhage transformation after thrombolytic therapy in patients with acute ischemic stroke, and deep hemorrhage transformation indicates that the patients have poor neurological outcomes after intravenous thrombolytic therapy.
【作者单位】：浙江大学医学院附属第二医院神经内科;
【基金】：浙江省杰出青年科学基金(LR12H09001) 浙江省科技厅重大科技专项计划(2013C13G2010032)
【分类号】：R743.3

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