急性缺血性卒中血管内治疗后实质性出血2型颅内出血的影响因素分析

Influencing factors of PH2 intracranial hemorrhage after endovascular treatment in acute ischemic stroke:analysis of 64 cases

目的探讨急性缺血性卒中血管内治疗后实质性出血(parenchymal hemorrhage, PH)2型颅内出血(intracerebral hemorrhage, ICH)的影响因素。方法纳入2020年4-12月在陆军军医大学第一附属医院神经内科住院且行血管内治疗的急性缺血性卒中患者共计64例。根据术后72 h内头颅CT判断患者是否存在PH2型颅内出血。回顾分析病例资料,包括年龄、性别、高血压病、糖尿病、高脂血症、冠心病、房颤、卒中史、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、血压、血糖、糖化血红蛋白、血小板、国际标准化比值(INR)、心源性栓塞、术前抗栓治疗、术前静脉溶栓、阿尔伯塔脑卒中计划早期诊断评分(Alberta Stroke Program Early CT Score, ASPECTS)等信息。结果纳入的64例患者均经过血管内治疗,术后72 h内诊断为ICH有28例(28/64,43.8%),其中PH2型ICH有9例(9/64,14.1%)。PH2组血糖(中位数,7.50 vs 6.58 mmol/L,P=0.039)、女性比例(77.8%vs 38.2%,P=0.035)、心源性栓塞比例(88.9%vs 49.1%,P=0.033)显著高于非PH2组;ASPECTS(中位数,6 vs 7,P=0.026)、ASPECTS>6分的比例(22.2%vs 63.6%,P=0.029)显著低于非PH2组。其中,血糖升高是发生PH2型颅内出血的危险因素(OR=1.48;95%CI=1.00~2.18)。结论急性缺血性卒中患者血糖升高可能增加血管内治疗后发生PH2型颅内出血的风险。

Objective To investigate the influencing factors of intracranial hemorrhage(ICH)of parenchymal hemorrhage type 2(PH2)after endovascular treatment(EVT)in patients with acute ischemic stroke(AIS).Methods A total of 64 AIS patients who were admitted to the First Affiliated Hospital of Army Medical University and received endovascular treatment from April 1,2020 to December 31,2020 were enrolled in this study,and the presence of PH2 ICH was determined by cranial CT scanning within 72 h after operation.The clinical data of the patients were collected and retrospectively reviewed,including age,gender,hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation,stroke history,National Institutes of Health Stroke Scale(NIHSS)score,blood pressure,blood glucose,glycosylated hemoglobin,platelet,international normalized ratio(INR),cardiogenic embolism,preoperative antithrombotic therapy,preoperative intravenous thrombolysis,and Alberta Stroke Program Early CT Score(ASPECTS).Results Among all the 64 patients,28 cases(28/64,43.8%)were diagnosed with ICH within 72 h after surgery,among which 9 cases(9/64,14.1%)had PH2 ICH.In the PH2 group,the median blood glucose(7.50 vs 6.58,P=0.039),proportion of women(77.8%vs 38.2%,P=0.035),and proportion of cardiogenic embolism(88.9%vs 49.1%,P=0.033)were significantly higher,whereas the median ASPECTS(6 vs7,P=0.026)and proportion of ASPECTS>6(22.2%vs 63.6%,P=0.029)were greatly lower than those of the non-PH2 group.In addition,the increased blood glucose presented as a risk factor for the occurrence of PH2 ICH(OR=1.48,95%CI:1.00~2.18).Conclusion Elevated blood glucose may increase the risk of developing PH2 ICH after EVT in patients with AIS.