脑梗死静脉溶栓后出血转化与脂质代谢异常的相关性研究

Correlation between Hemorrhagic Transformation and Abnormal Lipid Metabolism after Venous Thrombolysis in Patients with Cerebral Infarction

目的探讨急性缺血性卒中患者静脉溶栓后脂质代谢与出血转化的关系。方法回顾性分析2016年3月~2019年1月我院神经内科收治的急性缺血性卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓患者57例。溶栓后2h和24h分别行颅脑CT检查,收集患者的人口学资料(性别、年龄等)及脂质代谢相关指标。单因素分析是否发生出血转化患者上述指标的差异,利用ROC曲线将单因素分析中有意义的影响因素作为溶栓后出血转化预测因素进行分析。结果①接受静脉溶栓治疗后12例患者发生出血性转化,45例未发生出血转化,出血性转化发生率为21.05%;②单因素分析结果显示,出血转化患者静脉溶栓前基线血清脂蛋白a水平未发生出血转化患者,差异有统计学意义(P<0.05);③血清脂蛋白a预测出血转化的ROC曲线分析提示溶栓后发生出血转化的最佳分割点是114.50mg/L,敏感性为64.40%,特异性为75.00%,曲线下面积为0.701(95%CI:0.555~0.847),入院时Lp(a)水平≥114.50mg/L的患者出血转化率(9.38%)低于Lp(a)水平在0~114.50mg/L的患者(36.00%),差异有统计学意义(P<0.05)。结论缺血性脑卒中rt-PA静脉溶栓前基线血清脂蛋白a水平降低是出血转化的危险因素,针对血脂成分合理用药,调整脂代谢异常,预防和减少脑梗死后静脉溶栓出血转化的发生。

Objective To investigate the relationship between lipid metabolism and hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke.Methods A retrospective analysis of 57 patients with acute ischemic stroke and recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis was performed in our department of neurology from March 2016 to January 2019.CT scans were performed at 2 h and 24 h after thrombolysis,and demographic data (gender,age,etc.) and lipid metabolism related indicators were collected.Univariate analysis was performed to determine whether there was a difference in the above-mentioned indicators in patients with hemorrhagic transformation.The ROC curve was used to analyze the significant influencing factors in the single factor analysis as predictors of hemorrhagic transformation after thrombolysis.Results ①After intravenous thrombolysis,hemorrhagic transformation occurred in 12 patients,and 45 patients did not undergo hemorrhagic transformation.The incidence of hemorrhagic transformation was 21.05%.②Univariate analysis showed that patients with hemorrhagic transformation had no statistically significant changes in baseline serum lipoprotein a levels before intravenous thrombolysis (P<0.05).③The ROC curve analysis of serum lipoprotein a predicting hemorrhagic transformation suggests that the optimal segmentation point for hemorrhagic transformation after thrombolysis is 114.50 mg/L,sensitivity is 64.40%,specificity is 75.00%,and the area under the curve is 0.701 (95%CI):0.555~0.847),the bleeding conversion rate (9.38%) of patients with Lp(a) level ≥ 114.50 mg/L at admission was lower than that of patients with Lp(a) level between 0 and 114.50 mg/L (36.00%),the difference was statistically significant (P<0.05).Conclusion The decrease of serum serum lipoprotein a level in rt-PA before thrombolysis is a risk factor for hemorrhagic transformation.It is a rational use of blood lipid components to regulate abnormal lipid metabolism and prevent and reduce the conversion of intravenous thrombolytic hemorrhage after cerebral infarction.