阿替普酶静脉溶栓治疗后老年腔隙性脑梗死患者发生出血性转化的影响因素

Factors Influencing the Occurrence of Hemorrhagic Transformation in Elderly Patients with Lacunar Cerebral Infarction Treated with Intravenous Alteplase Thrombolysis

目的 分析阿替普酶静脉溶栓治疗后老年腔隙性脑梗死(LI)患者发生出血性转化(HT)的影响因素。方法 以河南省直第三人民医院2018年1月至2021年12月收治的60例老年LI患者为研究对象,根据阿替普酶静脉溶栓治疗后是否发生HT分为发生组(15例)、未发生组(45例)。收集两组临床资料,采用logistic多因素回归模型分析患者影响因素,通过受试者工作曲线(ROC)曲线分析logistic多因素回归模型对阿替普酶静脉溶栓治疗后LI患者发生HT的预测价值。结果 两组入院时美国国立卫生研究院卒中量表(NIHSS)评分、嗜酸性粒细胞数、脑白质病变、C反应蛋白(CRP)、D-二聚体相比,差异有统计学意义(P<0.05);logistic回归分析结果显示,入院时NIHSS评分(>11.88分)、嗜酸性粒细胞数(≤0.17×109L^(-1))、脑白质病变(中重度)、CRP(>9.21 mg·L^(-1))、D-二聚体(>2.75 mg·L^(-1))为阿替普酶静脉溶栓治疗后LI患者发生HT危险因素(P<0.05);采用logistic回归模型统计分析数据集,预测LI患者发生HT的敏感度为86.32%,特异度为84.14%。结论 LI患者阿替普酶静脉溶栓后发生HT受NIHSS评分、嗜酸性粒细胞数、脑白质病变、CRP、D-二聚体等多种因素影响,以相关因素为临床参考,对患者进行综合评估、针对性干预,有利于预防HT的发生。

Objective To analyze the factors influencing the occurrence of hemorrhagic transformation(HT) in elderly patients with lacunar cerebral infarction(LI) treated with intravenous thrombolysis with alteplase.Methods A total of 60 elderly patients with LI admitted to the Third People’s Hospital of Henan Province from January 2018 to December 2021 were studied, and were divided into the occurrence group(15 cases) and the non-occurrence group(45 cases) according to whether HT occurred after alteplase intravenous thrombolytic therapy. The clinical data of the two groups were collected. Logistic multifactorial regression models were used to analyze patient influencing factors. Receiver operating characteristic(ROC) curves were used to analyze the predictive value of logistic multifactor regression models for the occurrence of HT in patients with LI after alteplase intravenous thrombolytic therapy.Results There were significant differences in National Institute of Health stroke scale(NIHSS) score, eosinophil count, cerebral white matter lesions, C-reactive protein(CRP), D-dimer compared between the two groups(P<0.05). Logistic regression analysis showed that NIHSS score(>11.88 points), eosinophil count(≤0.17×10~9 L^(-1)), cerebral white matter lesions(moderately severe), CRP(>9.21 mg·L^(-1)), D-dimer(>2.75 mg·L^(-1)) were risk factors for the occurrence of HT in patients with LI after alteplase intravenous thrombolytic therapy(P<0.05). Statistical analysis of the data set using a logistic regression model predicted that the sensitivity for the occurrence of HT in patients with LI was 86.32% and the specificity was 84.14%.Conclusion The occurrence of HT after alteplase intravenous thrombolysis in patients with LI is influenced by various factors such as NIHSS score, eosinophil count, cerebral white matter lesions, CRP, D-dimer, etc. A comprehensive assessment and targeted intervention for patients with relevant factors as clinical reference is beneficial to prevent the occurrence of HT.