急性缺血性卒中患者静脉溶栓后不同部位出血转化的危险因素及预后分析

Risk factors of hemorrhagic transformation in different locations and its relation to clinical outcomes of patients with acute ischemic stroke following intravenous thrombolysis

目的：比较急性缺血性卒中患者静脉溶栓后发生不同部位出血转化的危险因素及溶栓后患者神经功能结局的差异,分析深部出血转化与非深部出血转化的独立预测因素,并了解不同梗死部位出血转化对急性缺血性卒中患者静脉溶栓后神经功能结局的影响.方法：回顾性分析2009年6月至2013年5月浙江大学医学院附属第二医院接受静脉溶栓治疗的急性缺血性卒中患者的临床及影像学资料.按照无出血转化、深部出血转化和非深部出血转化分成三组进行基线特征及神经功能结局的比较.三组间连续变量的比较用单因素方差分析,分类变量的比较用多组卡方检验,并用logistic 回归分析各部位出血转化的影响因素及其对预后的影响.结果：292例患者纳入分析,82例（28 1%）发生出血转化,其中深部出血47例（57 3%）、脑实质血肿型19例（6 5%）、出血性脑梗死型63例（21 6%）;症状性出血 8例（2 7%）.三组患者的年龄、基线NIHSS评分、收缩压以及心房颤动发生率差异有统计学意义（均P〈0 05）.校正后发现基线NIHSS评分（OR=1 126,95%CI：1 063~1 193,P〈0 001）和收缩压（OR=0 982,95%CI：0 967~0 998,P=0 025）是深部出血转化的独立影响因素.未发现非深部出血转化的独立危险因素.多因素分析显示,深部出血转化是影响溶栓后3个月神经功能结局的独立危险因素（OR=0 291,95%CI：0 133~0 640,P=0 002）.结论：基线神经功能缺损程度及收缩压是预测急性缺血性卒中患者溶栓后发生深部出血转化的独立危险因素,且深部出血转化提示患者静脉溶栓治疗后神经功能结局不良.

Objective： To investigate the risk factors of hemorrhagic transformation （HT） in different cerebral regions and to explore its relation to clinical outcomes of patients with acute ischemic stroke after intravenous thrombolysis therapy. Methods： The clinical, laboratory, and radiological data of 292 consecutive acute ischemic stroke patients undergoing intravenous thrombolysis therapy in Second Affiliated Hospital, Zhejiang University School of Medicine from June 2009 to May 2013 was retrospectively analyzed. Deep HT was defined as HT located in basal ganglia, internal capsule, external capsule and thalamus, otherwise the lesion was defined as non-deep HT. Patients were divided into 3 groups [Deep HT（n =47）, non-deep HT（n = 82）, non HT （n = 8 ）] and the differences in clinical and demographic characteristics were compared by using one-way analysis of variance and χ2-test. Muhivariable logistic regression models were used to determine the independent risk factors of HT in different cerebral regions and clinical outcomes. Results： Age, baseline National Institutes of Health Stroke Scale （NIHSS） score, baseline systolic blood pressure and the frequency of atrial fibrillation were different among three groups. Logistic regression analysis revealed that baseline NIHSS score （OR = 1. 126,95% CI： 1. 063-1. 193, P 〈 0.001 ） and baseline systolic blood pressure （ OR = 0.982,95 % CI： 0. 967-0. 998, P = 0.020 ） were independent risk factors of deep HT. Multivariate analysis also found that deep HT was an independent predictor of functional outcome after thrombolysis （ OR = 0. 291, 95% CI ： 0. 133-0. 640, P = 0. 002）. Conclusion： Baseline NIHSS score and systolic blood pressure are predictors for deep hemorrhagic transformation, which indicates the poor functional outcome of patients with acute ischemic stroke following thrombolytic therapy.