不同亚型急性脑梗死出血转化的发生及相关危险因素分析

The prevalence and related risk factors of hemorrhagic transformation in different subtype of cerebral infarction

目的研究不同亚型急性脑梗死出血转化的发生率及相关危险因素。方法选择南方医科大学南方医院及中山市人民医院神经内科自2008年1月至2011年12月收治的连续入院的急性脑梗死患者977例,按是否发生出血转化分为出血转化组(HT)142例及非出血转化组(NHT)835例,登记所有患者的基线资料并统计各病例的TOAST分型,分析不同亚型的急性脑梗死患者出血转化的发生率,采用Logistic回归分析脑出血转化的危险因素。结果大动脉粥样硬化性、心源性脑梗死、小动脉闭塞型脑梗死出血转化的发生率分别为12.8%、31.1%、6.6%;多因素Logistic回归分析显示出血转化的主要危险因素分别为大面积脑梗死(OR=10.498,95%CI6.520～17.131,P=0.000)、心房纤颤(OR=1.718,95%CI1.217～2.941,P=0.005)、糖尿病(OR=1.817,95%CI 1.135～2.903,P=0.012)及抗凝(OR=7.748,95%CI2.416～25.847,P=0.000)治疗。高血压、高低密度脂蛋白胆固醇以及抗血小板聚集治疗不是HT的独立危险因素。结论不同亚型脑梗死HT发生率不同,心源性脑梗死是脑出血转化的主要原因,大面积脑梗死、心房纤颤、糖尿病及抗凝治疗是HT的独立危险因素。

Objective To analyze the prevalence and related risk factors of hemorrhagic transformation （HT） in patients with different subtype of acute cerebral infarction. Mothod8 The Clinical data of 977 patients with cerebral infarction were analyzed retrospectively. They were divided into HT group （n=142） and non-HT group （n=835） according to whether they had HT or not. TOAST classification in both groups was observed. The risk factors for HT were identified by univariate chi-square test and multivariate logistic regression analysis, and the incidences of liT in various types of cerebral infarction in the TOAST classification were compared. Results The results of multivariate logistic regression analysis showed that massive cerebral infarction （OR=10.498,95%CI 6.520～17.131,P=.000）, atrial fibrillation （OR=1.718, 95%CI 1.217～2.941, P=-0.005）, anticoagulation （OR=7.748, 95%CI 2.416～25.847, P=-0.000）, and diabetes （OR=1.817, 95%CI 1.135 ～2.903, P=0.012） were the independent risk factors for HT. Hypertension, high cholesterol, and the history of anti-platelet aggregation were not the independent risk factors for HT. In the TOAST classification, the HT incidence in patients with cardio embolic cerebral infarction was the highest （31.1%, 88/283）, the HT incidence of small artery occlusion was lower （6.6%, 17/257）, and the HT incidence of large artery atherosclerosis was （12.8% , 24/187）. C, oavltufion Massive cerebral infarction, atrial fibrillation, anticoagulation, diabetes are the independent risk factors for HT. Cardioembolic cerebral infarction is one of the major reasons for the occurrence of liT.