脑梗死后出血性转化亚型危险因素分析

发布时间：2018-03-02 22:08

本文选题：脑梗死　切入点：出血性转化　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景脑梗死发病率、患病率、致残率高,随着中国老龄化年代的到来、头颅CT/MRI的普及和溶栓、取栓等技术的展开,脑梗死后出血性转化(HT)的发病率和诊断率不断上升,进一步了解HT及其不同亚型的危险因素,有利于进一步指导患者治疗、判断预后。目的探讨HT的危险因素及其不同亚型的危险因素差异,并分析中国缺血性卒中病因分型(CISS)与HT的关系,为患者的个体化治疗提供依据。资料与方法选择2014年1月~2016年1月收治的HT患者155例(HT组),进行连续性登记研究,并按照欧洲急性卒中合作组织将HT分为出血性脑梗死(HI)HI-1、HI-2型和脑实质血肿(PH)PH-1、PH-2型,抽取同期入院的无出血性转化脑梗死患者250例(非HT组),收集人口学、病史、临床、实验室检查及影像资料,分析HT及其不同亚型的危险因素。结果1.HT好发于脑梗死2周内,HT中HI-1比例最高,为43.87%(68/155);其次为HI-2,比例为33.55%(52/155),PH-1比例为12.26%(19/155);PH-2占比最低,为10.32%(16/155)。2.HT中CISS分型以大动脉粥样硬化性脑梗死和心源性脑梗死占比较高。3.单因素分析显示HT组患者大面积脑梗死、累及皮质、入院时NIHSS评分、抗血小板治疗、CISS分型等16项危险因素与非HT组比较差异有统计学意义(P0.05);多因素Logistic回归分析结果表明HT的独立危险因素是大面积脑梗死(OR=2.912,95%CI:1.521~5.575)、累及皮质(OR=2.664,95%CI:1.385~5.122)、入院时NIHSS评分(OR=1.066,95%CI:1.015~1.120)、年龄(OR=1.029,95%CI:1.005~1.054),HT不易发生在CISS分型中穿支动脉性疾病导致的脑梗死及低密度脂蛋白较高的患者。4.不同亚型HT与非HT组比较,累及皮质是HI-1型和PH-1型的独立危险因素,且对PH-1的影响更大;大面积脑梗死是影响HI-2型、PH-2型的独立危险因素,且对PH-2的影响更大;入院时NIHSS评分是影响HI-2型、PH-1型和PH-2型的独立危险因素,对PH-2影响最大;糖尿病史是HI-1型的独立危险因素;CISS分型中穿支动脉性疾病导致的脑梗死不易发生HI-1型。结论1.HT好发于脑梗死2周内,以HI-1最为多见。2.HT中CISS分型以大动脉粥样硬化性脑梗死和心源性脑梗死占比较高。3.大面积脑梗死、累及皮质、年龄、入院时NIHSS评分是HT的独立危险因素。4.HT亚型的独立危险因素存在差异,累及皮质、糖尿病是HI-1的独立危险因素,CISS中穿支动脉疾病导致的脑梗死不易发生HI-1;大面积脑梗死、入院时NIHSS评分是HI-2、PH-2的独立危险因素,且对PH-2的影响更大;累及皮质、入院时NIHSS评分是PH-1型的独立危险因素。
[Abstract]:Background the incidence, prevalence and disability rate of cerebral infarction are high. With the coming of aging age in China, the popularization of head CT/MRI, thrombolytic therapy and thrombolysis, the incidence and diagnosis rate of hemorrhagic transformation after cerebral infarction are increasing. To further understand the risk factors of HT and its different subtypes is helpful to guide the treatment of patients and judge the prognosis. Objective to explore the difference of risk factors of HT and its different subtypes. The relationship between CISS and HT was analyzed in order to provide basis for individualized treatment. Data and methods 155 cases of HT patients admitted from January 2014 to January 2016 were selected for continuous registration. According to the European Cooperative Organization for Acute Stroke, HT was divided into HI-1HI-2 type hemorrhagic cerebral infarction and PHPH-1H-2 type of cerebral parenchyma hematoma. 250 patients with non-hemorrhagic converted cerebral infarction (non-HT group) were selected to collect demography, medical history and clinical data. Laboratory examination and imaging data were used to analyze the risk factors of HT and its different subtypes. Results 1. The incidence of HT in patients with cerebral infarction within 2 weeks was the highest (43.87%, 68 / 155), followed by HI-2 (33.55%) with a ratio of 12.26% (12.26%) and a ratio of 12.26% (PH-2). The proportion of CISS typing in 10. 32% 16 / 155t 路2.HT was higher than that of atherosclerotic cerebral infarction and cardiogenic cerebral infarction. Univariate analysis showed that the patients in HT group had a large area of cerebral infarction, involving the cortex, and had a NIHSS score at admission. The results of multivariate Logistic regression analysis showed that the independent risk factors of HT were 2.912 ~ 95 CI: 1.521C: 5.575A, which involved the cortical cortex 2.66495 CIW 1.3855.122, and NIHSS score on admission. In the CISS typing, CI 1. 066 and 95% CI: 1.015 and 1. 120. The age of 1. 02995% CI: 1. 005 ~ 1.054% is not easy to occur in patients with cerebral infarction and high low density lipoprotein (LDL) caused by perforating arteriopathy in CISS typing. The comparison of different subtypes of HT with that of non HT group. The cortical involvement was an independent risk factor for HI-1 and PH-1, and had a greater impact on PH-1, whereas large area cerebral infarction was an independent risk factor for HI-2 type PH-2, and had a greater effect on PH-2. At admission, NIHSS score was an independent risk factor for HI-2 type PH-1 and PH-2 type, and had the greatest effect on PH-2. The history of diabetes mellitus is an independent risk factor of HI-1 type. Cerebral infarction caused by perforating artery disease is not easy to occur HI-1 type in Ciss classification. 1. HT preferentially occurs within 2 weeks of cerebral infarction. In HI-1, the most common type of CISS was atherosclerotic cerebral infarction (ACI) and cardiogenic cerebral infarction (ACI). 3. Large area cerebral infarction, involving cortex, age, On admission, NIHSS score was an independent risk factor of HT. 4. There were differences in the independent risk factors of HT subtype, which involved cortex, diabetes mellitus was an independent risk factor of HI-1. HI-1was not easy to occur in cerebral infarction caused by perforating artery disease in HI-1. NIHSS score was an independent risk factor for HI-2PH-2 and had a greater effect on PH-2, and NIHSS score was an independent risk factor for PH-1 type in cortical area.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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