血管内皮生长因子对抗凝联合抗血小板聚集治疗脑梗死患者出血转化的预测价值

The Predictive Value of VEGF for Anticoagulation Combined with Antiplatelet Aggregation in Treatment of Hemorrhagic Transformation in Patients with Cerebral Infarction

目的:探讨血清血管内生长因子(VEGF)水平对抗凝联合抗血小板聚集治疗脑梗死患者出血转化的独立风险因素和预测价值。方法:回顾性分析97例脑梗死急性期患者,依据6个月内是否发生脑出血,将其分为出血转化组(n=57)和未出血组(n=40),比较两组有关因素的差异,并采用COX回归分析患者发生出血转化的独立危险因素。用受试者工作特征曲线分析血清VEGF水平对患者发生出血转化的预测价值。结果:在年龄、女性患者、有糖尿病史、有高血压病史、有心脏病史、血清VEGF水平方面,两组差异有统计学意义(P<0.05)。进一步分析,有糖尿病病史(P=0.005)和血清VEGF水平升高(P=0.003)是脑梗死患者出血转化的独立风险因素。血清VEGF水平预测脑梗死出血转化的最佳临界值为240pg/ml,敏感度为50%,特异度为93%。结论:血清VEGF水平对采用抗凝联合抗血小板聚集治疗的脑梗死患者发生脑出血转化具有一定临床参考价值。

Objective:To explore whether the serum VEGF level is an independent risk factor and predictive value for hemorrhage transformation in patients with cerebral infarction treated with anticoagulation combined with antiplatelet aggregation.Method:97 patients with acute cerebral infarction were retrospectively analyzed.According to whether cerebral hemorrhage occurred within 6 months,they were divided into hemorrhagic transformation group(n=57)and non hemorrhagic group(n=40).The differences of related factors between the two groups were compared,and the independent risk factors of hemorrhagic transformation were analyzed by Cox regression.The predictive value of serum VEGF level for hemorrhagic transformation was analyzed by receiver operating characteristic curve.Results:There were significant differences in age,female patients,history of diabetes,history of hypertension,history of heart disease and serum VEGF level between the two groups(P<0.05).Further analysis showed that diabetes history(P=0.005)and elevated serum VEGF level(P=0.003)were independent risk factors for hemorrhagic transformation in patients with cerebral infarction.The best cut-off value of serum VEGF level in predicting hemorrhagic transformation of cerebral infarction was 240pg/ml,with sensitivity of 50%and specificity of 93%.Conclusion:Serum VEGF level,has certain clinical reference value for hemorrhage transformation in patients with cerebral infarction treated with anticoagulation combined with antiplatelet aggregation therapy.