急性脑梗死静脉溶栓后早期脑出血转化的相关因素分析

Analysis of factors that related to the early cerebral hemorrhagic transformation after intravenous thrombolysis in patients with acute cerebral infarction

目的:探讨影响急性脑梗死静脉溶栓早期脑出血转化的相关因素。方法:回顾性分析98例行静脉溶栓的急性脑梗死患者的临床资料,以溶栓后24 h及病情加重时头颅CT或MRI判断有无脑出血转化,比较脑出血转化组和无脑出血转化组患者的年龄、性别、高血压病史、糖尿病史、房颤、吸烟、发病至溶栓的间隔时间(<3 h或3～6 h)、溶栓前后的收缩压和舒张压、溶栓前血糖、溶栓前纤维蛋白原、溶栓前NIHSS评分、溶栓药物类型(rt-PA或UK)。使用Logistic回归分析以上与溶栓早期脑出血转化有关的因素。结果:本组急性脑梗死患者共98例,经溶栓治疗后发生脑出血转化(CHT)15例(15/98)。。CHT组心房颤动患者比率高于无CHT组(40%vs 12%,P=0.015),CHT组溶栓前NIHSS评分高于无CHT组(14 vs 10,P=0.025),CHT组溶栓后收缩压高于无CHT组(161±23 vs 139±20,P=0.003)。Logistic回归分析显示溶栓前NIHSS评分(OR=1.181,95%CI:1.037～1.346,P=0.012)、溶栓后收缩压(OR=1.079,95%CI:1.031～1.128,P=0.001)与溶栓后早期脑出血转化独立相关。结论:影响急性脑梗死静脉溶栓早期脑出血转化的相关因素有溶栓前NIHSS评分和溶栓后收缩压。

Objective：To investigate the factors that associated with the early cerebral hemorrhagic transformation（CHT） after intravenous thrombolysis in patients with acute cerebral infarction. Methods ： To analyze retrospectively the data of all 98 patients who had received intravenous thrombolytic therapy. CHT was assessed by CT or MRI performed at 24 h after treatment or sympotamatic deterioration within 24 h. Age, sex, history of hypertention and diabetes mellitus, smoking, atrial fibrillation, time from onset to treatment, systolic and diastolic blood pressure before and after treatment, baseline serum glucose and serum fibrinogen, NIHSS scores before treatment and type of thrombolytic medications were compared between patients with and without CHT. Logistic regression analysis was used to determine the independent factors associated to the CHT. Results：Fifteen patients had CHT. As compared to patients without CHT, patients with CHT had higher proportion of atrial fibrillation （40% vs 12% ,P = 0. 015 ） and higher NIHSS scores before treatment （14 vs 10 ,P = 0. 025 ）, as well as higher level of systolic blood pressure after treatment （161 ± 23 vs 139 ± 20 ,P = 0. 003 ）. Multiple logistic regression analysis showed that NIHSS scores before treatment（ OR = 1. 181,95% CI： 1. 037 - 1. 346,P = 0. 012） and systolic blood pressure after treatment （ OR = 1. 079,95 % CI： 1.031 - 1.128, P = O. 001 ） were independent factors that associated with the CHT. Conclusion：NIHSS scores before treatment and systolic blood pressure after treatment are factors that associated with the early CHT after intravenous thrombolysis in patients with acute cerebral infarction.