脑微出血与急性缺血性卒中患者尿激酶动脉溶栓后出血性转化的相关性：前瞻性病例系列研究

Correlation between cerebral microbleed and hemorhage transformation after urokinase intra-arteriai thrombolysis in patients with acute ischemic stroke： a prospective case series study

目的探讨脑微出血（cerebralmicrobleed，CMB）与急性缺血性卒中患者尿激酶动脉溶栓后出血性转化（hemorrhagetransformation，HT）的相关性。方法纳入接受尿激酶动脉溶栓的急性脑梗死患者，术前行MRI常规序列、磁敏感加权成像（susceptibility-weighted呻舀SWI）和CT扫描，术后48h内复查CT或M砌，根据是否出现HT将其分人HT组和非HT组。详细记录患者的人口统计学资料、血管危险因素和SWI序列显示的CMB数量并进行比较和分析。结果共纳入62例接受尿激酶动脉溶栓的急性脑梗死患者，其中HT组22例，非HT组40例。单变量分析显示，HT组高血压（81．8％对57．5％；x2=3．125，P=0．048）、糖尿病（63．6％对40．O％；X2=4．019，P=0．042）、吸烟（72．7％对37．5％；X2=4．971，P=0．030）和存在CMB（x2=5．297，P=0．018）的患者比例显著高于非HT组。多变量logistic回归分析显示，高血压[优势比（oddsratio，OR）1．51，95％可信区间（confidenceinterval，CI）1．102～2．954；P=0．028]、糖尿病（OR1．48，95％C／1．09～2．825；P：0．039）和CMB（OR1．867，95％C／1．103～3．158；P=0．020）是急性缺血性卒中患者尿激酶动脉溶栓后发生HT的独立危险因素。结论CMB是急性缺血性卒中患者尿激酶动脉溶栓后发生HT的独立危险因素之一。

Objective To investigate the correlation between cerebral microbleed （CMB） and hemorrhage transformation （HT） after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke. Methods The patients with acute cerebral infarction treated with intra-arterial urokinase were enrolled. They were divided into either an HT goup or a non-HT froup according to whether they had HT or not. Conventional MRI sequences, susceptibility-weighted imaging （SWI）, and CT scan were performed before procedure. CT or MRI was reexamined within 48 hours after procedure. The patients＇ demoffaphic data, vascular risk factors, and the SWI sequences showed the numbers of CMB were documented in detail and they were compared and analyzed. Results A total of 62 patients were included, 22 in HT group and 40 in non-HT group. Univariate analysis showed that the proportions of hypertension （81.8% vs. 57. 5%; X2 = 3. 125, P= 0. 048）, diabetes （63.6% vs. 40. 0% ; X2 = 4. 019, P = 0. 042）, smoking （72. 7% vs. 37. 5% ; X2 = 4. 971, P = 0. 030）, and presence of CMB （X2 = 5. 297, P = 0. 018） of patients in the HT group were sigaificantly higher than those inthe non-HT group. Multivariate logistic regression analysis showed that hypertension （odds ratio [ OR] 1.51, 95% confidence interval [ CI] 1. 102 - 2. 954; P = 0. 028）, diabetes （OR 1.48, 95% CI 1.09 - 2. 825; P = 0. 039）, and CMB （OR 1. 867, 95% CI 1. 103 -3. 158; P =0. 020） were the independent risk factors for HT after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke. Conclusions CMB was one of the independent risk factors for occurring HT after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.