急性缺血性卒中重组组织型纤溶酶原激活剂静脉溶栓致出血性转化及其预后的危险因素分析

Risk factors and prognosis for hemorrhagic transformation caused by intravenous thrombolysis treatment with recombinant tissue plasminogen activator treatment in acute cerebral infarction

目的探讨急性缺血性卒中重组组织型纤溶酶原激活剂（rt—PA）静脉溶栓后发生出血性转化（HT）的可能危险因素以及这些危险因素对患者预后的影响。方法128例急性缺血性卒中患者发病6h内接受rt—PA静脉溶栓治疗，选取溶栓前临床和实验室资料，通过比较HT组与非HT组之间的差异，筛选与HT相关的可能危险因素，并进一步通过Logistic回归分析影响HT及其预后的独立危险因素。结果128例溶栓患者有29例继发HT（22．66％），其中16例为症状性脑出血（12．50％），死亡2例，占HT的6．90％。Logistic回归分析表明房颤（OR=1．293，95％CI1．224～1．589，P=0．001）、早期CT改变（OR=2．452，95％CI1．132～3．309，P=0．034）、基线舒张压≥100mm Hg（1mmHg=0．133kPa，OR=9．265，95％CI1．435～59．836，P=0．019）、基线血糖≥11．1mmol／L（OR=3．037，95％C10．252—57．593，P=0．047）、NIHSS评分〉15分（OR=8．752，95％CI1．035—30．285，P=0．023）和溶栓时间窗〉3h（OR=98．74，95％CI5．067～186．120，P=0．002）6项为HT独立危险因素，其中基线血糖≥11．1mmol／L（OR=3．265，95％C10．435～59．863，P=0．045）、NIHSS评分〉15分（OR=10．453，95％CI5．647～38．185，P=0．003）和溶栓时间窗〉3h（OR=2．541，95％CI1．098～51．086，P=0．017）影响了HT患者的预后。结论溶栓前的舒张压、血糖水平、神经功能缺损程度、CT低密度改变或水肿占位效应、房颤和溶栓时间窗是HT的独立危险因素，其中基线血糖水平、神经功能缺损程度和溶栓时间窗影响了溶栓后HT患者的预后。

Objective To investigate risk factors and prognosis of hemorrhagic transformation （HT） in acute cerebral infarction patients treated by intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）. Methods All 128 patients with acute cerebral infarction were treated with intravenous rt- PA within 6 hours from stroke onset. The clinic records and laboratory datas of pre- and post-treatment were statistically analyzed between HT group and non-HT group to find potential risk factors to HT and contributors of prognosis. Results HT occurred in 29 patients （ 22. 66% ） , including 16 patients with symptomatic ICH （ 12. 50% ） and 2 patients died （6. 90% of HT）. Logistic regression analysis showed that history of atrial fibrillation（ OR = 1. 293,95% CI 1. 224--1. 589 ,P = 0. 001 ）, CT density changes with mass effect or edema（ OR = 2. 452,95% CI 1. 132-3. 309, P = 0. 034） , diastolic blood pressure ≥ 100 mm Hg before thrombolytic therapy （ 1 mm Hg = 0. 133 kPa, OR = 9. 265,95% CI 1. 435-59. 836, P = 0. 019 ） , blood glueose≥11. 1 mmol/L（OR =3. 037,95% CI 0. 252-57. 593 ,P =0. 047） , NIHSS score 〉 15 points （ OR = 8. 752,95% CI 1. 035-30. 285, P = 0. 023 ） and thrombolysis time 〉 3 h （ OR = 98.74,95% CI 5. 067-186. 120,P = 0.002）are independent risk factors for HT; among these factors, baseline bloodglucose （ OR = 3. 265,95% CI 0. 435-59. 863, P = 0. 045 ）, NIHSS score （ OR = 10. 453,95 % CI 5. 647- 38. 185 ,P = 0. 003 ） and thrombolysis time （ OR = 2. 541,95% CI 1. 098-51. 086, P = 0. 017 ） also are prediction factors of the prognosis of HT. Conclusion Risk factors associated with HT are diastolic blood pressure before thrombolysis, glucose level, degree of neurological deficits, CT early changes, atrial fibrillation and thrombolytic time. Glucose level, neurological deficits and thrombolysis time affects the prognosis of patients.