脑微出血与梗死后出血转化的相关性研究

Correlation between micro-bleeds and hemorrhagic transformation after ischemic stroke

目的：探讨脑微出血与梗死后出血转化的相关性。方法回顾性分析我院2009－2014年诊断急性脑梗死的患者145例，于入院后48 h完成头MRI T2？序列确定是否存在微出血，发病2周内复查MRI或头部CT为梗死后出血转化患者20例，梗死后非出血转化患者125例。结果梗死后出血转化组与梗死后非出血转化组相比较，微出血（ P＝0．170）、性别（ P＝0．671）、年龄（ P＝0．528）、高血压（ P＝0．597）、糖尿病（ P＝0．571）、高脂血症（ P＝0．772）、吸烟（ P＝0．672）、既往卒中（ P＝0．469）、凝血功能（P＝0．527）、抗血小板治疗（P＝0．642）、抗凝治疗（P＝0．611）两组间差异均无统计学意义；心房颤动[45％（9／20）与22％（28／125），P＝0．034]、NIHSS评分[（10．9±0．5）、（7．8±1．2）分，P＜0．001]、静脉溶栓治疗[20％（4／20）与5％（6／125），P＝0．015]在两组之间差异均有统计学意义。通过回归分析进一步发现，心房颤动（OR＝2．421，95％CI 1．823～3．256，P＝0．012）、NIHSS 评分（OR＝9．303，95％CI 3．094～27．970，P＜0．001）是梗死后出血转化的危险因素。结论微出血与梗死后出血转化之间无相关性，心房颤动、严重脑梗死是梗死后出血转化的独立危险因素。

Objective To investigate the correlation between micro-bleeds and hemorrhagic transformation（ HT ） after ischemic stroke. Methods One hundred and forty-five cases patients with acute ischemic stroke who were admitted to Luhe Hospital of Beijing Affiliated to Capital Medical University from 2009 to 2014 were retrospective analyzed. The MBs T2--weighted gradient-echo MRI was performed within 48 hours after admission to examine if there was a micro-bleeds,and the incidence of HT was assessed using follow-up brain MRI or CT in 2 weeks after admission. There were 125 patients with stroke were in without HT group and 20 patients were in HT group. Results There were no significant differences in terms of MBs （ P=0. 170 ） , gender（ P=0. 671 ） , age （ P=0. 528 ） , hypertension （ P=0. 597 ） , diabetes （ P=0. 571 ） , hyperlipidaemia （ P=0. 772）,smoking（P=0. 672）,history of stroke（P=0. 469）,coagulation function（P=0. 527）,antiplatelet（P=0. 642）,anticoagulation（P=0. 611） in HT group and without HT group. Atrial fibrillation（（45%（9/20） vs. 22%（ 28/125 ） , P = 0. 034 ） , NIHSS score （ 10. 9 ± 0. 5 ） points vs. （ 7. 8 ± 1. 2 ） points, P〈0. 001 ） , thrombolysis（20% （4/20） vs.5% （6/125）,P = 0.015） have significant differences in two groups.In multivariate logistic regression analysis,atrial fibrillation（ OR=2. 421,95%CI 1. 823-3. 256,P=0. 012） ,NIHSS score（ OR=9. 303, 95%CI 3. 094-27. 970, P〈0. 001 ） were independent predictors for HT after ischemic stroke. Conclusion There is no relationship between MBs and HT after ischemic stroke. Atrial fibrillation,the severe of stroke are independent predictors for HT after ischemic stroke.