抗血小板药物服用史与急性缺血性卒中静脉溶栓后颅内出血转化的相关性

Relationship between antiplatelet therapy history and hemorrhagic transformation in acute ischemic stroke after intravenous thrombolysis with recombinant tissue plasminogen activator

目的 探讨抗血小板药物服用史对急性缺血性卒中静脉溶栓后颅内出血转化的影响.方法 分析浙江西南地区6家大型综合性医院4.5h内接受静脉重组组织型纤溶酶原激活剂（rt-PA）溶栓治疗的急性缺血性卒中患者122例,根据治疗前是否服用抗血小板药物,将患者分为服用组（n=16）和未服用组（n=106）,分析两组患者的基线特点、颅内出血转化发生率和预后,通过Logistic回归分析研究抗血小板药物服用史对静脉溶栓后颅内出血转化的影响.结果 服用组患者的年龄明显高于未服用组[（69.1±7.0）岁与（62.3±11.7）岁,t=3.212,P=0.003],服用组患者颅内出血转化发生率明显高于未服用组[6/16与11.3％ （12/106）,x2=7.575,P=0.006].服用组与未服用组患者在溶栓后90 d良好预后比例（改良Rankin量表评分≤1分）的差异无统计学意义.单因素Logistic回归分析显示年龄（OR=1.087,95％ CI1.021 ～1.158,P=0.009）、抗血小板药物服用史（OR=4.700,95％ CI1.449 ～ 15.250,P=0.010）与静脉溶栓后颅内出血转化有关,单因素Logistic回归分析结果显示基线NIHSS评分（OR=1.263,95％ CI 1.126 ～1.404,P＜0.01）、舒张压（0R=1.037,95％ CI1.002 ～1.073,P=0.038）和血糖（OR=1.161,95％ CI 1.011～1.334,P=0.035）与患者90 d的预后相关.结论 抗血小板药物服用史可能增加急性缺血性卒中静脉溶栓治疗后颅内出血转化的风险,但并不影响患者90 d的良好预后.

Objective To investigate the influence of antiplatelet （AP） therapy history on hemorrhagic transformation （HT） in patients with acute ischemic stroke after intravenous thrombolysis.Methods The clinical data of 122 patients with acute ischemic stroke who had received recombinant tissuetype plasminogon activator （rt-PA） therapy （with 4.5 hours of stroke symptom onset） in 6 general hospital of southwest of Zhejiang Province were collected.Based on the history of AP therapy,the patients were divided into 2 groups：taking group （n =16） and non-taking group （n =106）.Baseline characteristics,the occurrence of HT and prognosis were analyzed.Logistic regression analysis was made to show the influence of AP therapy history on HT in acute ischemic stroke after intravenous thrombolysis.Results Patients in the taking group were older than that in the non-taking group （（69.1 ± 7.0） years vs （62.3 ± 11.7） years,t =3.212,P =0.003）.The frequency of HT incidents in the taking group was higher than that in the non-taking group （6/16 vs 11.3% （12/106）,x2 =7.575,P =0.006）.AP therapy history was not significantly associated with favorable outcome （modified Rankin Scale score ≤ 1） on day 90.In the univariate Logistic regression analysis,age （OR =1.087,95% CI 1.021-1.158,P =0.009） and AP therapy （OR =4.700,95% CI 1.449-15,250,P =0.010） were associated with HT after intravenous thrombolysis.The baseline of National Institute of Health Stroke Scale （NIHSS） score （OR =1.304,95% CI 1.151-1.477,P 〈0.01）,diastolic blood pressure （OR =1.037,95% CI 1.002-1.073,P =0.038） and （baseline）glucose （OR =1.161,95% CI 1.011-1.334,P =0.035） were associated with the favorable outcome on day 90.Conclusion AP therapy history may be the influence factor of HT,but is not associated with the favorable outcome on day 90 after thrombolytic therapy in patients with acute ischemic stroke.