脑梗死后出血性转化的临床特征及危险因素分析

Analysis on the clinical characteristics and related risk factors of patients with hemorrhagic transformation after cerebral infarction

目的分析脑梗死后出血性转化（HT）的临床特征及危险因素。方法回顾性总结脑梗死后发生HT患者49例，并随机选取同期住院急性脑梗死患者（未发生HT）106例作为对照。采用SPSS17．0统计软件，计数及计量资料分别应用Z、t检验，各指标采用单因素分析，再将差异有统计学意义的危险因素纳入logistic回归模型进行多因素分析。结果（1）HT组出血后临床症状加重21例（42．9％），其中表现为意识障碍程度加重8例、偏瘫加重7例和出现头痛头晕或加重5例；（2）梗死后15d内发生HT占87．0％；（3）皮层梗死、大面积脑梗死、心房纤颤（房颤）、脑栓塞、糖尿病、低密度脂蛋白胆固醇升高均增加脑梗死后HT的风险（P〈0．05），其中以脑栓塞及房颤影响最大；（4）HT各亚型中以脑实质血肿形成2（PH-2）型出现临床症状的概率较高。结论大动脉主干闭塞较易发生HT，且多在脑梗死后15d内发生，其短期预后与分型有关；皮质梗死、大面积脑梗死、房颤、脑栓塞、糖尿病、低密度脂蛋白胆固醇升高是HT的危险因素。

Objective To analyze and summarize the clinical characteristics and risk factors for patients with hemorrhagic transformation （HT） after cerebral infarction to provide guidance for its clinical treatment and prevention. Methods In this study, data from 49 hospitalized patients with HT in the First Department of Neurology, China-Japan Union Hospital of Jilin University from October 2009 to March 2012, were reviewed retrospectively and 106 cases with acute cerebral infarction only during the same period, were chosen randomly as controls. Gender and age of the patients were comparable. Relevant information was collected. SPSS 17.0 statistical package was applied for data processing. Qualitative data were processed with ;（2 test, and measurable data was processed with t-test. Each index was analyzed with uni-variate analysis while statistically significant risk factors were included in the logistic review model to conduct the multivariate regression analysis. Results （1） Clinical symptoms deteriorating after hemorrhage in 21 cases accounted for 42.9% of the HT group, among which the cases on degree of disturbance to consciousness had an aggravation in 8 cases and hemiplegia increase in another 7 cases. Headaches and dizziness were found in 5 cases. （2） Number of infarction within 15 days after the occurrence of HT accounted for 87.0%. （3）HT-related factors increased the risk of HT in cerebral infarction such as cortical infarction, large area of infarction, atrial fibrillation, cerebral embolism, diabetes and high level of low-density lipoprotein cholesterol （P〈0.05）. The most important factors were atrial fibrillation and cerebral embolism. （4） PH-2 seemed more unlikely to link with clinical symptoms than other subtypes of HT. Conclusion Cerebral infarction after occlusion of the main artery tnmk was prone to HT, especially when it appeared within 15 days. Short-term prognosis seemed to be related to the subtypes of HT, with risk factors as cortical infarct, massive cerebral infarction, atrial fibrillation, cerebral embolism, diabetes, high low-density lipoprotein cholesterol etc. on HT.