降纤治疗急性脑梗死后出血性转化的原因及危险因素分析

Causes and risk factors of hemorrhagic transformation after defibrinolysis for acute cerebral infarction

目的研究降纤治疗急性脑梗死后出血性转化的原因及相关危险因素。方法选取2015-02—2017-02至河南医学高等专科学校附属医院接受降纤治疗的120例急性脑梗死患者为研究对象,按照降纤治疗后是否产生出血性转化分为A组(n=28)与B组(n=92),A组有出血性转化,B组无出血性转化,比较2组临床资料,总结出血性转化相关危险因素。结果 2组年龄、病史、治疗前空腹血小板、收缩压、低密度蛋白、脉压差及纤维蛋白原比较无明显差异(P>0.05);A组NIHSS评分、大面积脑梗死率、皮层梗死率、空腹血糖水平、心源性脑栓塞率及治疗前空腹尿酸水平明显高于B组(P<0.05);Logistic多因素分析显示,NIHSS评分、大面积脑梗死、心源性脑栓塞属于降纤治疗急性脑梗死后出血性转化主要独立危险因素(P<0.05)。结论NIHSS评分、尿酸值、大面积脑梗死、皮层梗死、心源性脑栓塞及空腹血糖高均为降纤治疗急性脑梗死后出血性转化原因,其中心源性脑栓塞、NIHSS评分高及大面积脑梗死属于出血性转化主要独立危险因素。

Objective To study the causes and risk factors of hemorrhagic transformation after defibrinolysis for acute cerebral infarction.Methods 120 patients with acute cerebral infarction who underwent defibrinolysis in the hospital from February2015 to February 2017 were selected as the subjects.According to the occurrence of hemorrhagic transformation after defibrinolysis,they were divided into group A（with hemorrhagic transformation,n=28）and group B（without hemorrhagic transformation,n =92）.The clinical data were compared between the two groups,and risk factors of hemorrhagic transformation were summarized.Results There was no significant difference in age,medical history,fasting platelet,systolic blood pressure,low density protein,pulse pressure or fibrinogen between the 2 groups before treatment（P〉0.05）.The NIHSS score,rate of large area cerebral infarction,rate of cortical infarction,the fasting blood glucose level,rate of cardiogenic cerebral embolism and the fasting uric acid level before treatment in group A were significantly higher than those in group B（P〈0.05）.Logistic multivariate analysis showed that NIHSS score,large area cerebral infarction and cardiogenic cerebral embolism were the main independent risk factors of hemorrhagic transformation after defibrinolysis for acute cerebral infarction（P〈0.05）.Conclusion NIHSS score,uric acid,large area cerebral infarction,cortical infarction,cardiogenic cerebral embolism and high fasting blood glucose are causes of hemorrhagic transformation after defibrinolysis for acute cerebral infarction,and cardiogenic cerebral embolism,high NIHSS score and large area cerebral infarction are the main independent risk factors for hemorrhagic transformation.