急性脑梗死后出血转化临床特征及影响预后的危险因素分析

Clinical features of hemorrhagic transformation after acute cerebral infarction and risk factors of prognosis

目的探讨急性脑梗死后出血转化(hemorrhagic transformation,HT)临床特征,并分析影响预后的危险因素。方法回顾性分析40例HT患者的临床特征。根据预后情况将其分为良好组22例和不良组18例,比较两组临床病例资料,分析影响预后的危险因素。结果HT临床特征:HT患者中,脑叶梗死占52.50%,大面积梗死占65.00%,心源性脑栓塞型(cardioembolism,CE)占62.50%;HT发生在发病后8~14 d占57.50%;出血性梗死(hemorrhagic infarction,HI)占90.00%,脑实质内血肿(parenchyma haematoma,PH)占10.00%;HT发生后症状加重占42.50%。良好组和不良组性别、吸烟史、卒中史、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、服用抗凝药物差异有统计学意义(P<0.05)。多因素分析结果表明,NIHSS评分>12分、服用抗凝药物是影响预后的危险因素,差异有统计学意义(P<0.05)。结论脑叶梗死、大面积梗死和CE型的急性脑梗死患者更容易发生HT,HT多发于急性脑梗死后8~14 d内,多数为HI型,大部分患者不会发生症状加重。NIHSS评分>12分、服用抗凝药物是影响HT患者预后的危险因素。

Objective To explore the clinical features of hemorrhagic transformation(HT)after acute cerebral infarction(ACI),and to the analyze risk factors of prognosis.Methods The clinical features of 40 HT patients who were admitted to the hospital were retrospectively analyzed.According to different prognosis of HT patients,they were divided into good group(22 cases)and bad group(18 cases).The clinical case data in both groups were retrospectively collected.The risk factors that affected prognosis of patients were analyzed.Results The clinical features of HT:In HT patients,lobe infarction,large area infarction and cardioembolism(CE)accounted for 52.50%65.00%and 62.50%,respectively.The occurrence of HT at 8-14 d after onset accounted for 57.50%.The patients with hemorrhagic infarction(HI)and parenchyma haematoma(PH)accounted for 90.00%and 10.00%,respectively.After HT,the patients with symptom aggravation accounted for 42.50%.The results of univariate analysis showed that stroke history,gender,age,score of National Institutes of Health Stroke Scale(NIHSS)and taking anticoagulants were related with prognosis(P<0.05).The results of multivariate analysis showed that NIHSS scores higher than 12 points and taking anticoagulants were independent risk factors of prognosis(P<0.05).Conclusion Patients with lobe infarction,large area infarction and ACI of CE type are more likely to be accompanied with HT.HT mostly occurs at 8-14 d after after ACI,most of which is HI type.There is no symptom aggravation in most of patients.NIHSS score higher than 12 points and taking anticoagulants are independent risk factor of prognosis in HT patients.