脑梗死后自发性出血转化的相关危险因素分析

Relevant risk factors of spontaneous hemorrhagic transformation after cerebral infarction

目的 探讨急性脑梗死自发性出血转化（HT）的相关危险因素。方法 对北京市海淀医院神经内科2011年6月至2014年12月收治的409例未溶栓治疗的脑梗死患者进行研究;其中HT组42例,非HT组367例。回顾性分析2组患者的临床指标,筛选急性脑梗死自发性HT的相关危险因素。结果 HT组患者脑白质病变、卒中史、糖尿病、高血压、心房颤动（房颤）、大面积脑梗死的发生率及24 h收缩压变异系数（CV）、舒张压CV水平均高于对照组（P〈0.05）。logistic回归分析显示,脑白质病变（OR=1.794,95%CI 1.086~2.593,P=0.005）、房颤（OR=1.811,95%CI1.122~9.819,P=0.018）、大面积脑梗死（OR=6.527,95%CI 3.998~9.901,P=0.000）、收缩压CV（OR=1.994,95%CI1.158~4.876,P=0.022）、舒张压CV（OR=3.014,95%CI 2.121~5.032,P=0.008）是急性脑梗死自发性HT的独立危险因素。结论 脑白质病变、房颤、脑梗死面积和血压变异性是急性脑梗死自发性HT的独立危险因素,能够预测自发性HT的发生。

Objective To explore the relevant risk factors for spontaneous hemorrhagic transformation（HT） after acute cerebral infarction. Methods A total of 409 patients with cerebral infarction without thrombolytic therapy were en- rolled in the study from June, 2011 to December, 2014. The HT group included 42 cases, and the non-HT group included 367 cases. Clinical indicators were analyzed retrospectively, and were compared between the two groups. Results The prevalence of leukoaraiosis, history of stroke, diabetes mellitus, hypertension, atrial fibrillation, massive cerebral infarc- tion, 24h systolic and diastolic blood pressure coefficient of variation （CV） in the observation group were significantly higher than those in the control group （P 〈 0.05）. The results of multivariate logistic regression analysis revealed that leu- koaraiosis（OR=l.794, 95%CI 1.086-2.593, P = 0.005）, atrial fibrillation（OR=l.811, 95%CI 1.122-9.819, P = 0.018）, mas- sive cerebral infarction（OR=6.527,95%CI 3.998-9.901, P = 0.000）, 24h systolic blood pressure CV （OR=1.994, 95%CI 1.158-4.876, P = 0.022）, diastolic blood pressure CV（OR=3.014, 95%CI 2.121-5.032, P = 0.008） were independent risk factors for HT after acute cerebral infarction. Conclusion Leukoaraiosis, atrial fibrillation, cerebral infarction area and blood pressure variability are the independent risk factors for HT after acute cerebral infarction.These can predict the oc- currence of HT.