脑梗死后出血性转化的临床特征及危险因素分析

The clinical features of hemorrhagic transformation after cerebral infarction and the analysis of risk factors

目的观察脑梗死后出血性转化(HT)的临床特征,对相关危险因素进行总结,以指导疾病的诊断、治疗及预防。方法搜集2010年9月至2013年3月期间住院脑梗死患者160例,根据有无HT分为HT组42例,非HT组118例。在入院后记录患者临床表现,以及患者的基本情况如年龄、性别、既往病史、梗死面积、尿蛋白等,以及发病前后应用溶栓、抗凝和抗血小板聚集药物等情况、出血部位等危险因素,以筛选出与HT相关的危险因素。结果 HT组临床特征中偏瘫占76.1%,失语占50.0%,意识障碍26.2%,头痛头晕21.4%。危险因素中与脑梗死后HT的发病有密切关系包括高胆固醇血症、大面积脑梗死、房颤病史、尿蛋白的出现等。其他几项急性脑梗死基本危险因素,包括:年龄、吸烟、酗酒等,两组组间比较,差异无统计学意义(P>0.05)。结论患者大面积脑梗死、尿蛋白阳性、高胆固醇血症及房颤史可能是脑梗死后出血性转化的主要危险因素,多种因素共同作用导致脑梗死后出血性转化。

Objective To summarize the clinical features of hemorrhagic transformation （HT） after cerebral infarction and analyze the related risk factors, in order to guide the diagnosis, treatment and prevention of the disease. Methods The clinical data of 160 patients with cere- bral infarction were collected. The patients were treated in our hospital from September 2010 to March 2013. The patients with HT or without HT were assigned to HT group （ n = 42） and NHT group （ n = 118 ） respectively. The following data were obtained including basic information of the patients （age, sex, medical history）, clinical manifestation, infarction area, bleeding site, thmmbolysis and administration of anticoagulation and antiplatelet aggregation drugs before and after the onset of the disease and urine protein. The risk factors associated with FIT were analyzed. Results Clinical features of patients in HT group were hemiplegia （76.1%）, aphasia （50.0%）, disturbance of consciousness （26.2%）, and head- ache and dizziness （21.4%）. Risk factors for HT after cerebral infarction included hypercholesterolemia, large area cerebral infarction, history of atrial fibrillation and urine protein positive. However, there were no statistically significant differences in age, smoking and alcohol abuse between HT and NHT group （ P 〉 0.05 ）. Conclusion Hemorrhagic transformation after cerebral infarction may be the result of joint action of many fac- tors; large area cerebral infarction, positive urine protein, hypereholesterelemia, and a history of atrial fibrillation are major risk factors for FIT.