脑梗死静脉溶栓后出血转化的危险因素及预后

Risk Factors and Prognosis of the Hemorrhagic Transformation Following Thrombolysis in Cerebral Ischemia

目的:观察急性脑梗死溶栓治疗后出血转化(HT)的危险因素及继发HT患者的预后。方法:回顾性分析我院60例急性脑梗死经静脉溶栓治疗患者的临床资料,对溶栓后继发HT的危险因素进行统计学分析。在溶栓后通过改良Rankin量表(m RS)对出院90 d的患者生活状况进行评估,分析继发HT对远期预后的影响。结果:HT组13例,无HT组47例。单因素分析显示,与无HT组比较,HT组患者中多数存在房颤史、溶栓前血糖水平及NIHSS评分高(均P<0.05),且HT组大面积脑梗死、脑白质疏松改变的患者比例偏高(均P<0.05)。Logistic多因素回归分析发现房颤(P<0.05)、大面积脑梗死(P<0.05)、脑白质疏松改变(P<0.05)是继发HT的危险因素。与无HT组比较,HT组出院90 d后m RS评分较高(P<0.05)。结论:房颤、大面积脑梗死、脑白质疏松改变是溶栓后继发HT的危险因素;继发HT的患者远期MRS评分较高。

Objective： To observe the risk factors and prognosis of hemorrhagic transformation （HT） in acute cere-bral infarction patient following thrombolytic treatment. Methods： The clinical data of 60 cases treated with intra-venous thrombolysis was retrospectively summarized. Risk factors for HT following thrombolysis were analyzed. Living quality of patients were evaluated by modified Rankin Scale （mRS） after thrombolysis and 90 days after dis-charge to analyze the effect of the secondary HT on long-term prognosis. Results： There were 13 cases in the HT group, and 47 cases in the non-HT group. Univariate analysis indicated that the following factors might be risks for HT, including history of atrial fibrillation, large area infarction, leukoaraiosis, hyperglycaemia before thrombolysis, and higher NIHSS scores.And the patients with large area infarction, leukoaraiosi in the HT group were more than non-HT group. Logistic regression analysis revealed that history of atrial fibrillation, large area infarction, and leukoaraiosis were closely associated with the presence of HT （P〈0.05） respectively. Moreover, mRS scores were higher 90 days after discharge in the HT group than that in the non-HT group （P〈0.05）. Conclusion： History of atrial fibrillation, large area infarction and leukoaraiosis are risk factors for HT in acute cerebral infarction patients fol-lowing thrombolytic treatment. The secondary HT patients have relatively higher mRS scores.