梗死体积及相关生化指标对心源性卒中抗凝治疗后早期出血性转化的预测价值

目的探讨心源性脑卒中患者抗凝治疗后出血性转化与治疗前MRI梗死体积及相关生化指标的相关性。方法2017年3月至2020年3月心源性卒中行抗凝治疗的患者306例,其中69例接受利伐沙班治疗,57倒接受达比加群治疗,120例接受华法林治疗,60例接受阿司匹林治疗。所有患者入院时均行头颅MRI及相关生化指标检查,入组30 d行磁共振磁敏感成像明确是否有出血性转化。结果利伐沙班组出血性转化发生率为21.7%,达比加群组发生率为31.6%,华法林组发生率为25.6%,阿司匹林组发生率为0%,D-二聚体、空腹血糖、MRI梗死体积对抗凝剂治疗心源性卒中出血性转化具有诊断效应(P<0.05)。结论D-二聚体、空腹血糖及MRI梗死体积对心源性卒中抗凝治疗后出血性转化具有预测价值。

Objective To investigate the relationship between hemorrhagic transformation after anticoagulation therapy in patients with cardiogenic stroke and the MRI infarct volume and related biochemical indicators before treatment.Methods 246 patients who underwent anticoagulation therapy for cardiogenic stroke in our hospital from March 2017 to March 2020 were analyzed.Among them,69 received rivaroxaban,57 received dabigatran,and 120 received warfarin treatment.All patients underwent cranial MRI and related biochemical index examinations on admission.Magnetic resonance susceptibility imaging was performed 14 days after admission to determine whether there was hemorrhagic transformation.Results The incidence of hemorrhagic transformation in the rivaroxaban group was 21.7%,the incidence in the dabigatran group was 31.6%,the incidence in the warfarin group was 25.6%,and the incidence of the aspirin group was 0%,D-II polymer,fasting blood glucose,and MRI infarct volume had diagnostic effects on hemorrhagic transformation of cardiogenic stroke with anticoagulants(P<0.05).Conclusion D-II polymer,fasting blood glucose and MRI infarct volume have predictive value for hemorrhagic transformation after anticoagulant therapy in cardiogenic stroke.