脑卒中溶栓后出血性转化与临床预后研究

Hemorrhagic Transformations and Prognoses in Stroke Patients with Thrombolysis

目的阐明中国汉族人急性脑卒中溶栓后出血性转化与临床预后的关系。方法采用二分类Logistic回归回顾性分析脑卒中溶栓队列出血性转化和预后关系。结果共纳入102例患者,男性44例(43.1%),女性58例(56.9%);年龄中位数73岁;溶栓无出血转化73例(74.5%),梗塞性出血12例(12.2%),脑实质性出血13例(13.3%)。预后良好44例(43.6%),预后不良57例(56.4%)。溶栓后ASPECT评分可预示出血性转化(OR0.15)和预后不良(OR0.20);血肌钙蛋白水平同样预示出血转化(OR27.42)和不良结局(OR12.16)。其他独立影响因素为脉搏数(OR2.18)和NIHSS评分(OR2.00),但出血转化本身与预后无相关性。结论溶栓后低ASPECT评分、基线高血肌钙蛋白水平、高NIHSS评分和高脉搏计数可以预测溶栓后3个月不良预后,出血性转化可能与预后无关。

Objective To clarify the relations of hemorrhagic transformations and functional outcomes in Chinese stroke patients with thrombolysis. Method A retrospective cohort study with logistic regression analyses was performed. Results A total of 102 patients were included. Forty-four （43.1%） were males and 58（56.9%） were females. The median of age was 73. No hemorrhagic transformation was observed in 73（74.5%） patients, while hemorrhagic infarction in 12（12.2%） and parenchymal hemorrhage in 13 （ 13.3% ）. Forty-four （43.1%） patients got favorable outcome and 57 （56.4%） with unfavorable one. Lower ASPECT scale after thrombolysis（OR=0.15 and 0.20） and higher baseline troponin level（OR= 27.42 and 12.16） independently correlated with hemorrhagic transformation and unfavorable outcomes, respectively. Other predictors of unfavorable outcome were high NIHSS scale （OR=2.00） and high pulse count （OR=2.18）. Conclusions Lower ASPECT scale after thrombolysis, higher serum troponin level, higher NIHSS scale and high pulse count might independently predict 90-day unfavorable outcome in Chinese patients with thrombolysis. Hemorrhagic transformation might not correlate with functional outcome.