脑梗死后出血转化与脑微出血及其它危险因素的相关性研究

Relationship between hemorrhagic transformation after acute ischemic infarction and cerebral microbleeds or other related risk factors

目的研究急性脑梗死后出血转化（HT）与脑微出血（CMB）及其它危险因素的相关性，并探讨其预防方法。方法选择自2009年6月至2010年12月在广州中医药大学中山附属医院及南方医科大学附属南方医院神经内科连续住院、资料完整的急性脑梗死患者348例．登记患者的基线资料，行MRI GRE-T2＊WI扫描，检查CMB的患病率和HT的发生率。以HT为因变量，其它因素为自变量，进行Logistic回归分析以探索HT的影响因素。结果急性脑梗死348例患者中发生HT35例（10．06％），其中大动脉粥样硬化性脑梗死213例患者中发生HT19例（8．92％），心源性脑栓塞28例患者中发生HT11例（39．29％1，不明病因脑梗死19例患者中发生HT5例（26．32％1．腔隙性脑梗死88例患者中无HT发生。Logistic回归分析显示，HT的危险因素为心源性脑栓塞（OR=5．338，95％CI：1．926～14．796．P=-0．001）、不明病因脑梗死（OR=6．843，95％CI：1．848-25．346，p=-0．004）及NIHSS评分（OR：1．181，95％CI：1．085～1．284，P=-0．000），低密度脂蛋白为保护性因素（OR=0．637，95％CI：0．414-0．979，P=-0．040）。结论急性脑梗死后HT在不同亚型脑梗死中发病率不同，心源性脑栓塞中HT发病率最高。HT的危险因素为心源性脑栓塞、不明病因脑梗死及NIHSS评分，低密度脂蛋白为HT的保护性因素，CMB与HT没有明显相关性。

Objective To investigate the relationship between hemorrhagic transformation （HT） after acute ischemic infarction and cerebral microbleeds （CMB） or other related risk factors, and analyze the possible preventive methods of HT. Methods Three hundred and forty-eighty in-patients with acute infarction, consecutively admitted to our hospitals from June 2009 to December 2010, were included and related risk factors were registered. All patients were performed GRE-T2＊WI to detect the presence of CMB and hemorrhage transformation. Logistic regression analysis was used to assess the relationship between HT and related risk factors by Forward Stepwise. Results HT occurred in 35 （10.06%） of the 348 patients with acute infarction. Nineteen patients （8.92%） experienced HT in 213 patients with atherosclerotie infarction. Eleven patients （39.29%） experienced HT in 28 patients with cardioembolic infarction and 5 （26.32%） experienced HT in 19 patients with undetermined etiology infarction. No patient experienced HT in patients with lacunar infarction. The results of multivariate binary logistic regression showed that risk factors of CMB were cardioembolic infarction （OR=5.338, 95%CI： 1.926-14.796, P=-0.001）, undetermined etiology infarction （OR=6.843, 95%CI 1.848-25.346, P=0.004）, and scores ofNIHSS （OR=l.181, 95% CI： 1.085-1.284, P=0.000）, and that protective factor was low density lipoprotein （OR=0.637, 95%CI： 0.414-0.979, P=0.040）. Conclusion The rates of HT vary in different subtypes of acute ischemic infarction and the rate of HT among cardioembolic infarction is the highest. The risk factors of HT are cardioembolic infarction, undetermined etiology infarction, and scores of NIHSS, and the protective factor is low-density lipoprotein. CMB is not related with HT.