急性脑梗死出血性转化患者血清肿瘤坏死因子-α水平的变化及相关因素分析

Changes of serum TNF-α levels in hemorrhagic transformation of acute cerebral infarction and a- nalysis of the risk factors

目的观察急性脑梗死尤其伴发出血性转化患者血清肿瘤坏死因子-α（TNF-α）含量水平的动态变化．探讨TNF-α在脑梗死出血性转化发病机制中所起的作用及脑梗死出血性转化患者的临床特点和相关危险因素。方法将2011年2月至2012年6月收治的198例脑梗死患者分为脑梗死出血性转化组（48例）及单纯脑梗死组（150例），采用放射免疫分析法于发病第1、4、7、10天连续检测48例急性脑梗死出血性转化患者、150例单纯脑梗死患者和45例正常对照组TNF-α含量，进行各组间比较分析。采用Logistic回归模型分析急性脑梗死出血性转化的危险因素。结果急性脑梗死出血性转化患者于发病第1天TNF-α开始升高（P〈0．05），第4天达到峰值水平（P〈0．01），然后逐渐下降，至第10天时仍高于对照组和单纯脑梗死组（P〈0．05）。梗死体积大、继发出血量多，TNF-α水平就越高，与其他各组相比差异有统计学意义（P〈0．05，〈0．01）。研究发现脑栓塞、皮质梗死、大面积脑梗死、高血糖为脑梗死出血性转化的独立危险因素，溶栓治疗可增加出血性转化的危险性，而抗凝治疗与出血转化无明显相关性。结论TNF-α水平的动态变化与急性脑梗死，尤其伴发出血性转化的发生发展明显相关，脑梗死出血性转化患者血清TNF-α水平升高明显；TNF-α水平升高持续时间越长，脑组织损害就越严重。其中心源性脑栓塞、皮质部位梗死、大面积脑梗死、高血糖、溶栓治疗与脑梗死出血性转化有一定的相关性。

Objective To investigate the dynamic changes of serum tumor necrosis factor-α （TNF-α） levels in patients with acute cerebral infarction especially with hemorrhagic transformation （HT）, and investigate the effect of TNF-α on the pathogenesis of hemorrhagic transformation of acute cer- ebral infarction, and the clinical feature and the risk factors of hemorrhagic transformation of cerebral in- farction. Methods One hundred and ninety-eight patients with cerebral infarction and 45 normal con- trois were included into this study from February 2011 to June 2012. There were 48 patients with hemor- rhagic transformation of acute cerebral infarction, and 150 cases of purely cerebral infarction. Radioim- munoassay was used to continuously detect the serum levels of TNF-α on 1 st, 4 th, 7 th and 10 th day in all patients and normal controls. Logistic regression analysis was used to find out the risk factors of hem- orrhagic transformation of cerebral infarction. Results Serum levels of TNF-α in acute cerebral infarc- tion patients with hemorrhagic transformation began to rise on the first day of onset （ P 〈 0.05 ） , and reached peak levels on the fourth day （P 〈 0.01 ） , and then decreased gradually, but was still high- er than that in normal control group and purely cerebral infarction group on the tenth day （ P 〈 0.05 ） As the focal infarction size and the hematoma presented more larger, the serum TNF-α level would be more higher. Compared with other groups, the differences were significant （P 〈 0.05 or 〈 O. 01 ）. Cerebral embolism, cerebral cortex infarction, massive cerebral infarction, hyperglycemia were the independent risk factors for the hemorrhagic transformation of cerebral infarction. The throm- bolytic therapy could increase the risk of hemorrhagic transformation, but anticoagulation therapy was not related to the hemorrhagic transformation. Conclusions The dynamic change of serum TNF-α levels is correlated with the occurrence and development of cerebral infarction especially with hemorrhagic transformation （HT） , the serum TNF-α level in hemorrhagic transformation of cerebral infarction is higher and the elevated lev- els of TNF-α keep more longer, the brain damage is more serious. Cerebral embolism, cerebral cor- tex infarction, massive cerebral infarction, hyperglycemia are correlated with HT. Thrombolytic thera- py is correlated with the occurrence of hemorrhagic transformation of cerebral infarction.