嗜酸性粒细胞绝对值计数与急性缺血性卒中患者rt-PA静脉溶栓后出血性转化的关系研究

Study on Association of Absolute Eosinophil Count with Hemorrhagic Transformation of Acute Ischemic Stroke Patients after rt-PA Intravenous Thrombolysis

目的:探讨嗜酸性粒细胞绝对值计数与急性缺血性卒中(AIS)患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后出血性转化(HT)的关系。方法:回顾分析2017年6月至2019年6月我院神经内科收治的170例AIS患者病历资料,通过单因素分析研究年龄、入院美国国立卫生研究院卒中患者神经功能缺损(NIHSS)评分、嗜酸性粒细胞绝对值计数等与HT的关系,多因素Logistic回归模型分析rt-PA静脉溶栓后HT的影响因素。结果:170例AIS患者中,经rt-PA静脉溶栓后HT占10.59%(18例);单因素分析发现HT组和非HT组在年龄、入院NIHSS评分、肾小球滤过率(eGFR)、嗜酸性粒细胞数、糖尿病、高血压、房颤例数上比较,差异具有统计学意义(P<0.05);Logistic回归分析发现年龄、入院NIHSS评分、eGFR、嗜酸性粒细胞绝对值计数、糖尿病、高血压、房颤均与溶栓后HT发生有关(P<0.05)。且调整年龄等因素带来的混杂后,较嗜酸性粒细胞绝对值计数<0.11×10^9·L^-1的患者而言,嗜酸性粒细胞绝对值计数≥0.11×10^9·L^-1的AIS患者rt-PA静脉溶栓后出现HT风险降低57.2%。结论:较高嗜酸性粒细胞绝对值计数与rt-PA静脉溶栓后低HT风险相关,故而AIS患者入院时嗜酸性粒细胞绝对值计数可以作为rt-PA静脉溶栓后HT发生的独立预测标志物。

Objective:To investigate the association of absolute eosinophil count with hemorrhagic transformation(HT)of acute ischemic stroke(AIS)patients after rt-PA intravenous thrombolysis.Methods:Retrospective analysis was conducted on the medical records of 170 AIS patients who were treated at the neurology department of our hospital from June 2017 to June 2019.Univariate analysis was adopted to assess correlation between age,NIHSS score at admission,absolute eosinophil count,etc.and HT,then multi-factor Logical regression model was used to evaluate the risks for HT after rt-PA intravenous thrombolysis.Results:Among 170 AIS patients,10.59%(18 cases)presented HT after rt-PA intravenous thrombolysis.There was statistically significant difference between the HT group and the non-HT group in age,NIHSS score at admission,eGFR,absolute eosinophil count,and patients number of diabetes mellitus,hypertension,atrial fibrillation(P<0.05).Multi-factor Logical regression analysis revealed that age,NIHSS score at admission,eGFR,absolute eosinophil count,diabetes mellitus,hypertension and atrial fibrillation were risks of HT(P<0.05).Furthermore,after adjusting confounding factors,HT occurrence risk for patients with absolute eosinophil count≥0.11×10^9·L^-1 reduced by 57.2%compared with patients with absolute eosinophil count<0.11×10^9·L^-1.Conclusion:High absolute eosinophil count is associated with lower HT occurrence risk after rt-PA intravenous thrombolysis,indicating the absolute eosinophil count at admission can be an independent predictive marker for HT after rt-PA intravenous thrombolysis.