急性脑梗塞非溶栓治疗后出血性转化的危险因素分析

Risk factor analysis of hemorrhagic transformation of acute cerebral infarction after non-thrombolytic therapy

目的分析急性脑梗塞患者非溶栓治疗后出血性转化(hemorrhagic transformation,HT)的危险因素及意义。方法通过回顾性分析将146例急性脑梗塞患者按是否出现出血性转化分为HT组和非HT组,记录患者的临床资料,包括一般资料、既往史、NIHSS评分和梗塞面积,以及实验室检查结果,通过单因素分析及Logistic回归分析确定影响HT的危险因素。结果 146例患者中36例出现HT,单因素分析显示HT组心房颤动病史、梗塞面积、血浆S-100β蛋白浓度、NSE水平均明显高于非HT组,而LDL水平则低于非HT组,差异均有统计学意义(P <0. 05)。多因素Logistic回归显示,梗塞面积、NSE和S-100β蛋白水平为HT的独立危险因素(P <0. 05)。结论大面积脑梗塞、高浓度血浆NSE和S-100β蛋白是急性脑梗塞患者非溶栓治疗后继发HT的独立危险因子,通过评估梗塞面积以及检测二者水平可以对脑梗塞后发生HT进行预测,对临床有重要的指导意义。

Objective To analyze the risk factors and effects of hemorrhagic transformation（ HT） of acute cerebral infarction after non-thrombolytic therapy. Methods A total of 146 cases were retrospectively divided into HT and non-HT（ NHT）groups according to whether the objects had HT. Clinical data including general information,previous history,scores of NIHSS,and infarct area,as well as results of experimental examination were recorded,and univariate analysis and Logistic regression were used for determining the risk factors of HT. Results HT was detected in 36 of 146 patients. Univariate analysis showed that the history of atrial fibrillation,infarct size,plasma S-100β protein concentration,and NSE level in the HT group were significantly higher than those in the non-HT group,while the LDL level was lower than that in the non-HT group,with the differences statistically significant（ P 0. 05）. Logistic regression analysis indicated that infarct area,serum NSE and S-100βlevel were independent risk factors for HT（ P 0. 05）. Conclusion Large infarct area,high level of NSE and S-100β were independent risk factors for HT in acute cerebral infarction patients without thrombolysis. By evaluating the infarct area,and testing the levels of these two elements,doctors can predict the occurring of HT at early stage,which possesses a significant value for clinical practice.