脑梗死后自发性出血性转化与预后的相关性

Correlation of spontaneous hemorrhagic transformation and its prognostic correlation in acute cerebral infarction

目的 探讨脑梗死后自发性出血性转化（HT）与预后的关系.方法 选择2011年11月至2012年7月在我院神经内科连续入院的所有脑梗死患者,全面收集可能与预后相关的临床及实验室检查数据.入院3d内或病情加重时复查头颅CT或MRI,根据是否出现HT将患者分为出血组（HT组）和非出血组（NHT组）.发病后3个月进行电话随访,了解预后情况.结果 共入选337例患者,HT组44例,3个月末HT组死亡3例（6.8％）,不良预后（死亡＋残疾）21例（47.7％）;NHT组293例,3个月末死亡21例（7.2％）,死亡＋残疾104例（35.5％）,两组不良预后比较差异无统计学意义（x^2 =3.104,P=0.376）.多因素Logistic分析显示：影响3个月末不良结局的独立危险因素是年龄（OR=1.054,95％ CI为1.021～ 1.087）、性别（OR =2.131,95％CI为1.151 ～3.945）、美国国立卫生院神经功能缺损评分（OR=1.275,95％ CI为1.174～ 1.384）.结论 自发性HT不是导致3个月末死亡或不良结局的独立危险因素,及时发现自发性HT,尽早调整治疗方案对预后无明显不良影响.

Objective To investigate the relationship between spontaneous hemorrhagic transformation and prognosis after cerebral infarction.Methods Three hundred and thirty-seven cases with acute ischemic stroke at the Brain Hospital Affiliated to Nanjing Medical University from Nov.2011 to Jul.2012 were selected as our subjects.All the relevant clinic and laboratory examination data which influencing spontaneous hemorrhagic transformation were collected.Brain CT or MRI within 3 d after admission or when neurological deficit deterioration happened was performed.Based on brain CT scan or MRI,patients were divided into hemorrhagic transformation（HT） group or non-HT（NHT） group.All cases were followed up for 3 month.Results All of 337 patients,44 cases occurred in spontaneous hemorrhagic transformation,accounting for 13.1%.The mortality rate was 6.8% （3 cases） in 3 months followed-up at HT group,and the death/disability rate was 47.7% （21 cases）.Meanwhile,the mortality rate was 7.5% （21 cases） in 3 months followed-up at NHT group,and the death/ disability rate was 35.5% （104 cases）.There was no significant difference between the two groups（x^2 =3.10,P =0.376）.Multivariate logistic regression analysis demonstrated that age （OR =1.054,95 % CI 1.021-1.087）,gender（OR =2.131,95% CI 1.151-3.945） and the national institutes of health stroke scale（OR =1.275,95% CI 1.174-1.384） were independent predictors of death/dependence at 3 months after ischemic stroke attacked.Conclusion Spontaneous hemorrhagic transformation is not the risk factor of death/dependence on 3 month after symptom onset for ischemic stroke patients.Spontaneous hemorrhagic transformation should be detected as early as possible and adjusted therapy scheme in time,which will help in terms of prognosis.