急性大面积脑梗死发生出血性转化的相关危险因素分析

Analysis of Related Risk Factors of Hemorrhagic Transformation in Acute Massive Cerebral Infarction

目的探讨急性大面积脑梗死(acute massive cerebral infarction,AMCI)患者出血性转化(hemorrhagic transformation,HT)的危险因素,并寻找可能的预测因子。方法回顾性分析2017年9月至2020年6月上海市第六人民医院金山分院收治的156例AMCI患者的临床病历资料,根据患者入院2周内是否并发HT将其分为HT组(n=49)和NHT组(n=107)收集研究对象临床病历资料,采用多因素Logistic回归分析AMCI患者并发HT的影响因素,并绘制受试者工作特征(ROC)曲线评估影响因素对HT的预测价值。结果HT组年龄大于NHT组,收缩压、空腹血糖(FBG)、白细胞计数(WBC)、中性粒细胞计数(NEUT)、中性粒细胞计数/淋巴细胞计数(NLR)水平高于NHT组,低密度脂蛋白(LDL-C)、淋巴细胞计数(lymphocyte count,LY)水平低于NHT组。多因素Logistic回归结果显示,FBG、WBC、NEUT、NLR升高是AMCI患者并发HT的独立危险因素(OR=1.108、1.319、1.269、1.635,P均<0.05),LDL-C、LY升高是AMCI患者并发HT的保护因素(OR=0.854、0.925,P均<0.05)。NLR能有效预测AMCI患者HT发生,AUC为0.816(95%CI:0.755~0.861),截断值为7.30,灵敏度、特异性分别为77.14%、86.59%,准确性为82.23%。结论高血糖以及WBC、NEUT、NLR升高是AMCI患者发生HT的独立危险因素,LDL-C和LY升高是保护因素,其中NLR能有效预测AMCI患者HT发生风险。

Objective To explore the risk factors of hemorrhagic transformation(HT)in patients with acute massive cerebral infarction(AMCI)and to find out the possible predictors.Methods The clinical data of 156 patients with AMCI admitted to Jinshan Branch of Shanghai Sixth People's Hospital from September 2017 to June 2020 were analyzed retrospectively,they were divided into HT group(n=49)and NHT group(n=107)according to whether the patients had HT within 2 weeks after admission.The clinical data of subjects were collected.The influencing factors of HT in patients with AMCI were analyzed by multivariate Logistic regression and the receptor operating characteristic(ROC)curve was drawn to evaluate the predictive value of influencing factors on HT.Results The age of HT group was higher than that of NHT group,systolic blood pressure,fasting blood glucose(FBG),white blood cell count(WBC),neutrophil count(NEUT)and neutrophil/lymphocyte count(NLR)were higher than NHT group,and low density lipoprotein(LDL-C)and lymphocyte count(LY)levels were lower than those of NHT group.Multivariate logistic regression results showed that the increase of FBG,WBC,NEUT and NLR were the independent risk factors of HT in patients with AMCI(OR=1.108,1.319,1.269,1.635,P all<0.05),and the increase of LDL-C,LY were the protective factors of HT in patients with AMCI(OR=0.854,0.925,P all<0.05).NLR could effectively predict the occurrence of HT in patients with AMCI,and the AUC was 0.816(95%CI:0.755 to 0.861),the cut-off was 7.30,and the sensitivity and specificity were 77.14%and 86.59%respectively,and the accuracy was 82.23%.Conclusion Hyperglycemia and elevated WBC,NEUT,NLR are the independent risk factors of HT in patients with AMCI,elevated LDL-C and LY are protective factors.NLR can effectively predict the risk of HT in patients with AMCI.