脑梗死发病前使用抗栓药物治疗对急性脑梗死后出血转化的影响分析

Analysis of the effects of anti thrombotic drugs before cerebral infarction in patients with acute cerebral infarction

目的探讨脑梗死发病前使用抗栓药物治疗对急性脑梗死后出血转化的影响分析。方法回顾性分析神经内科2012年1月至2015年1月间住院的5 967例急性脑梗死患者。收集所有患者入院时的基础资料、抗栓药物(溶栓、抗凝或抗血小板聚集药物)的使用情况以及CT/MRI等影像学资料。按照入院后72 h复查的影像学结果,将脑梗死发病出血转化的患者入组出血转化组,非出血转化的患者入组非出血转化组是按1︰1入组,且患者的年龄、性别构成比均与出血转化组患者相匹配。比较两组患者发病前用药情况,比较两组患者入院前后美国国立卫生研究院卒中量表(NIHSS)评分、影像学监测到的脑梗死面积、糖尿病史、入院24 h内的血压、心房颤动;采用多因素Logistic回归方法对差异有统计学意义的指标进行分析,确定脑梗死后出血转化的危险因素,并对比抗栓药物治疗对急性脑梗死后出血转化发生率的影响。结果本次研究选取5 967例病例,符合标准共纳入728例。统计学分析显示两组患者脑梗死面积、NIHSS评分、心房颤动、发病前抗栓药物治疗的差异有统计学意义,出血转化组患者发病前进行溶栓治疗以及使用抗凝药物的比率显明显高于非出血转化组(P<0.07)。结论脑梗死面积、NIHSS评分、心房颤动比率、发病前抗栓药物治疗为急性脑梗死后出血转化的危险因素,其中发病前进行溶栓治疗、使用抗凝药物与急性脑梗死后出血转化密切相关,但与预后的远期影响关系有待进一步研究。

Objective To investigate the effect of anti - thrombotic drugs（anti - coagulation or anti - platelet aggregation drugs）on the bleeding and transformation of patients with acute cerebral infarction before the onset of cerebral infarction. Methods Retrospective analysis was performed in 5 967 patients with acute cerebral infarction,who admitted in our hospital from January 2012 to January 2015. The basic data of all patients,the use of anti - thrombotic drugs（anti - thrombolysis,anti - coagulation or anti - platelet aggregation drugs）and CT/ MRI and other im-aging data were enrolled. According to the imaging data results of 72 hours after admission,the hemorrhagic transformation patients were enrolled in the hemorrhagic transformation group,the non - hemorrhagic transformation patients were enrolled into non - hemorrhagic transformation group according to the 1： 1 ratio,and the gender and age were matched between the two groups. Two groups of patients before the onset of medication, National Institutes of Health Stroke Scale（NIHSS）scores,the monitored the area of cerebral infarction,diabetes history,24 h blood pressure after admission and the atrial fibrillation were compared. The data of different statistical significance risk factors were analyzed in the multivariate Logis-tic regression analysis method,to determine the risk factors of hemorrhagic transformation after cerebral infarction,and to compare the effect of anti- thrombotic drugs on the incidence of hemorrhagic transformation after acute cerebral infarction. Results 728 of 5 967 cases with acute cerebral infarction were enrolled. Statistical analysis shows the statistical significances of cerebral infarction,NIHSS scores,atrial fibrillation,anti - throm-botic therapy before the onset of cerebral infarction. The proportion of patients with hemorrhagic transformation group before the onset of thrombolyt-ic therapy and anti - coagulant drugs increased significantly. Conclusion The cerebral infarction area,NIHSS scores,atrial fibrillation ratio and anti - thrombotic drugs for acute cerebral infarction before cerebral infarction were risk factors,and the use of anti - coagulant drugs and acute cer-ebral infarction were closely related,but the long - term impacts of its relationship need to be further studied.