时间窗内急性脑梗死应用阿替普酶静脉溶栓后出血转化相关因素的分析及预测

Analysis and prediction of factors related to hemorrhagic transformation after intravenous thrombolysis with alteplase in acute cerebral infarction

目的研究预测窗内急性脑梗死(ACI)应用阿替普酶(rt-PA)静脉溶栓后出血转化(HT)的相关危险因素。方法纳入本院2016年6月至2019年10月收治的80例急性脑梗死患者进行临床研究,所有患者均给予阿替普酶静脉溶栓治疗,根据静脉溶栓治疗后24~72 h是否发生HT分为转化组(n=28)与非转化组(n=52),根据所有患者的临床资料采用多因素logistic回归分析ACI患者rt-PA静脉溶栓治疗后发生HT的独立危险因素。结果两组临床资料比较,转化组与非转化组性别、年龄、合并症(高血压、高血脂、糖尿病)、既往脑梗死病史、起病至溶栓治疗时间、溶栓前舒张压、溶栓前收缩压、溶栓后24 h舒张压及溶栓前血小板计数比较差异均无统计学意义(均P>0.05);两组既往口服抗血小板药物史、心房颤动、溶栓前NIHSS评分、溶栓前血糖及溶栓后24 h收缩压比较差异均有统计学意义(均P<0.05)。经多因素logistic回归分析,心房颤动(OR=2.995,95%CI:2.142-5.315)、溶栓前NIHSS评分(OR=3.459,95%CI:1.988-6.547)、溶栓前血糖(OR=10.135,95%CI:6.457-13.631)及溶栓后24 h收缩压(OR=2.319,95%CI:1.346-3.247)为预测rt-PA静脉溶栓后HT的独立危险因素(均P<0.05)。结论针对时间窗内行rt-PA静脉溶栓治疗的ACI患者,若未有效控制心房颤动、溶栓前NIHSS评分、溶栓前血糖及溶栓后24 h收缩压可致发生HT的风险增高,可作为预测HT的独立危险因素。

Objective To investigate the risk factors associated with hemorrhagic transformation(HT)after intravenous thrombolysis with alteplase(rt-PA)in acute cerebral infarction(ACI).Methods A total of 80 patients with acute cerebral infarction from our hospital were enrolled into this clinical study,between June 2016 and October 2019.All patients were treated with alteplase intravenous thrombolytic therapy.The patients who suffered from HT within 24 to 72 hours after intravenous thrombolytic therapy were set as the transformation group(n=28),and the other patients were set as the non-transformation group(n=52).Multivariate logistic regression was used to analyze the independent risk factors of HT after rt-PA intravenous thrombolytic therapy in ACI patients.Results There were no statistically significant differences in gender,age,comorbidities(hypertension,hyperlipidemia,and diabetes),history of previous cerebral infarction,time of thrombolytic therapy after onset of ACI,diastolic blood pressure before thrombolysis,systolic blood pressure before thrombolysis,platelet count before thrombolysis,or 24-hour diastolic blood pressure after thrombolysis between the transformation group and the non-transformation group(all P>0.05);there were statistically significant differences in previous oral antiplatelet drugs,atrial fibrillation,NIHSS score before thrombolysis,blood glucose before thrombolysis,and 24-hour systolic blood pressure after thrombolysis between the transformation group and the non-transformation group(all P<0.05).The result of multivariate logistic regression analysis showed that atrial fibrillation(OR=2.995,95%CI:2.142-5.315),NIHSS score before thrombolysis(OR=3.459,95%CI:1.988-6.547),blood glucose before thrombolysis(OR=10.135,95%CI:6.457-13.631),and 24-hour systolic blood pressure after thrombolysis(OR=2.319,95%CI:1.346-3.247)were the independent risk factors for predicting HT after rt-PA intravenous thrombolytic therapy in ACI patients(all P<0.05).Conclusion As the independent risk factors for predicting HT,the atrial fibrillation,NIHSS score before thrombolysis,blood glucose before thrombolysis,and 24-hour systolic blood pressure after thrombolysis should be effectively control to reduce the risk of HT after intravenous thrombolysis with alteplase(rt-PA)in patients with ACI.