脑小血管病严重程度与脑梗死静脉溶栓后症状性颅内出血的相关性分析

目的分析脑小血管病(CSVD)严重程度与脑梗死静脉溶栓后症状性颅内出血的相关性。方法选取2015年3月至2018年12月急性脑梗死行静脉溶栓治疗患者302例,按其溶栓后是否发生症状性颅内出血分为未出血组和出血组。比较两组CSVD总体负荷评分的差异,分析CSVD严重程度与溶栓后发生颅内出血的相关性。结果302例接受静脉溶栓治疗的急性脑梗死患者中,发生症状性颅内出血21例(6.09%)。单因素分析显示,年龄、基线NIHSS评分、发病至溶栓治疗间隔时间(OTT)、C反应蛋白、国际标准化凝血酶原比值(INR)、凝血酶原时间(PT)、高血压、心房颤动和CSVD严重程度是影响症状性颅内出血是否发生的影响因素;Logistic回归分析显示,心房颤动(OR=27.031,95%CI 4.696~155.599,P=0.001)与溶栓后症状性颅内出血的发生独立相关,以轻度CSVD为参照,重度CSVD与症状性颅内出血的发生独立相关(OR=33.683,6.832~166.075,P<0.001)。结论CSVD严重程度与脑梗死静脉溶栓后症状性颅内出血独立相关,且重度CSVD是溶检后症状性颅内出血的独立危险因素。

Objective To observe the correlation between the severity of cerebrovascular disease and symptomatic intracranial hemorrhage afer intravenous thrombolysis of cerebral infarction.Method 302 patients with acute cerebral infarction treated by intravenous thrombolysis from March 2015 to December 2018 were divided into non-bleeding group and bleeding group according to whether symptonatic intracranial hemorrhage occurred after thrombolysis.The diference of CSVD load score between the two groups was compared,and the relationship between the severity of CSVD and intracranial hemorrhage after thrombolysis was analyzed by single factor and mulifactor logistic regression.Results Among 302 patients with acute cerebral infarction receiving intravenous thrombolysis,21(6.09%)had symptomatic intracranial hemorrhage.Univariate amalysis showed that age,baseline NIHSS score,time between onset and thrombolytic therapy(OTT),C-reactive protein,international standardized prothrombin raio(INR),prothrombin time(PT),byetension,atrial fillation and severity of CSVD were the influencing factos of symptomatic intracranial hemorrthage;multivariate logistic regression analysis showed that atrial filtion(OR=27.031,95%CI 4.696~155.599,P=0.001)was independently related to the occurrence of symptomatic intracranial hemorthage afer thrombolysis.With mild CSVD as the reference,severe CSVD was independently related to the occurrence of symptomatic intracranial hemorrhage(OR=33.683,6.832~166.075,P<0.001).Conclusion Alpha-lipoic acid combined with butylphthalide can efectively improve the therapeutic efect of acute cerebral infarction with type 2 diabetes melitus,and can effectively inhibit oxidative stress response and reduce the level of inflammatory factors in patients with acute cerebral infarction.