糖化血红蛋白与急性缺血性脑卒中溶栓后症状性脑出血的相关性研究

Study on correlation between glycosylated hemoglobin and symptomatic intracerebral hemorrhage after thrombolytic therapy in acute ischemic stroke

目的研究糖化血红蛋白与急性缺血性脑卒中患者重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓治疗后症状性脑出血的相关性。方法回顾性分析2018年1月至2021年9月在上海交通大学医学院附属同仁医院接受rt-PA静脉溶栓治疗的367例急性缺血性脑卒中患者的临床数据。在性别、年龄、吸烟史、溶栓时间窗、治疗前英国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、高血压病史、心房颤动病史、糖尿病史、糖化血红蛋白、血糖值及血压值方面,利用logistic回归分析溶栓治疗后症状性脑出血发生的相关因素。结果367例急性缺血性脑卒中患者静脉溶栓治疗后7 d内出现症状性脑出血共40例。Logistic回归分析结果显示,糖化血红蛋白水平和溶栓前NIHSS评分是溶栓后7 d内症状性脑出血发生的独立危险因素[比值比(odds ratio,OR)=1.218,95%置信区间(confidence interval,CI):1.017~1.460,P=0.033;OR=1.128,95%CI:1.073~1.187,P<0.001]。结论糖化血红蛋白水平可作为rt-PA静脉溶栓治疗后症状性脑出血发生的预测因素,较高水平的糖化血红蛋白预示较高的症状性脑出血发生风险。

Objective To investigate the correlation between glycosylated hemoglobin and symptomatic intracerebral hemorrhage after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke.Methods The clinical data of 367 patients with acute ischemic stroke who received intravenous thrombolytic therapy with rt-PA in Tongren Hospital,Shanghai Jiao Tong University School of Medicine from January 2018 to September 2021 were retrospectively analyzed.Logistic regression was used to analyze the relevant factors of symptomatic intracerebral hemorrhage after thrombolytic treatment in terms of gender,age,smoking history,thrombolytic time window,NIHSS score before treatment,history of hypertension,history of atrial fibrillation,history of diabetes,glycosylated hemoglobin,blood glucose and blood pressure value.Results Among 367 patients with acute ischemic stroke,40 patients occurred symptomatic cerebral hemorrhage within 7 days after intravenous thrombolytic therapy.Logistic regression analysis showed that glycated hemoglobin level and NIHSS score before thrombolysis were independent risk factors for symptomatic cerebral hemorrhage within 7 days after thrombolysis[odds ratio(OR)=1.218,95%confidence interval(CI):1.017-1.460,P=0.033;OR=1.128,95%CI:1.073-1.187,P<0.001].Conclusion The glycosylated hemoglobin level can be used as a predictor of symptomatic intracerebral hemorrhage after intravenous thrombolytic therapy with rt-PA.Higher glycosylated hemoglobin level predicts higher incidence of symptomatic intracerebral hemorrhage.