急性脑梗死自发性出血转化发生率及危险因素分析

Analysis of incidence rate and risk factors for spontaneous hemorrhagic transformation in acute cerebral infarction patients

目的探讨急性脑梗死(acute cerebral infarction,ACI)自发性出血转化(hemorrhagic transformation,HT)发生率及危险因素。方法回顾性分析比较216例常德市第一人民医院神经内科2018年1月-2019年1月连续入住经药物保守治疗的ACI患者临床资料,采用单因素和多因素Logistic回归分析相关危险因素,并进行曲线拟合以及阈值效益分析。结果216例ACI患者中,27例在住院期间发生自发性HT,比例为12.5%。多因素Logistic回归分析显示,TOAST分型为心源性栓塞型(OR=11.05,95%CI 1.97~61.98;P=0.0063)、入院第一天美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分高(OR=1.6,95%CI 1.3~2.0;P<0.001)、入院时排除炎性反应外周白细胞计数过多(OR=1.41,95%CI 1.01~1.95;P=0.0408)是ACI后HT的独立危险因素;应用平滑曲线拟合分析发现,入院时排除炎性反应外周白细胞计数与ACI后自发性HT呈正相关(P<0.05)。结论入院时排除炎性患者外周白细胞计数可作为ACI患者住院期间是否发生HT的预测指标。

Objective To investigate the incidence rate and risk factors for spontaneous hemorrhagic transformation(HT)in acute cerebral infarction(ACI)patients.Methods We retrospectively reviewed the clinical records of 216 ACI patients undergoing drug conservative treatment in the First People’s Hospital of Changde City from January 2018 to January 2019.According to the occurrence of the spontaneous HT in each person within 14 days after onset,all patients were divided into two groups:the HT group and none-HT group,the clinical data between each group were be compared,univariate and multivariate logistic regression were used to analyze the relevant risk factors,the association between the risk factor and the spontaneous HT were further assessed by linear regression models and smooth curve fitting in addition to threshold effect analysis.Results Among 216 patients with ACI,27 cases(12.5%)had spontaneous HT during hospitalization.Multivariate logistic regression analysis showed that the etiological types in the trial of Org10172 in acute stroke treatment(TOAST)of cardiac embolism(CE)(OR=11.05,95%CI 1.97~61.98;P=0.0063),high National Institutes of Health Stroke Scale(NIHSS)score on the first day of admission(OR=1.6,95%CI 1.3~2.0;P<0.001),and excessive peripheral leukocyte counts excluding inflammatory response at admission(OR=1.41,95%CI 1.01~1.95;P=0.0408)were independent risk factors for the spontaneous HT after ACI.Smooth curve fitting analysis showed that the peripheral white blood cell count and the occurrence of the spontaneous HT were positively correlated.Conclusion TOAST classification of CE,high NIHSS score on the first day of admission and excessive peripheral leukocyte counts excluding inflammatory response at admission were independent risk factors of spontaneous HT after ACI.The excessive peripheral leukocyte counts after acute cerebral infarction,independently of the occurrence of infections,could be a potential predictor of the spontaneous HT after ACI.