老年颅内大血管急性闭塞患者短期内出血转化的风险及相关危险因素研究

Risk for short-term hemorrhage transformation and risk factors in elderly patients with acute occlusion of large intracranial vessels

目的 探讨老年颅内大血管急性闭塞患者短期内出血转化(HT)的风险及相关危险因素。方法 回顾性选取2017年1月至2021年12月河北中石油中心医院及解放军总医院第一医学中心收治的143例老年颅内大血管急性闭塞患者,根据发病后90 d内是否发生HT分为HT组43例和非HT组100例,进行多因素logistic回归分析。结果 多因素回归分析显示,发病至血管再通时间延迟(OR=5.088,95%CI:1.050~24.650,P=0.043)、溶栓前血浆凝血酶原时间>16 s(OR=4.977,95%CI:1.126~21.992,P=0.034)、病变位置为前循环(OR=3.629,95%CI:1.059~12.427,P=0.040)、病因为心源性栓塞(OR=3.788,95%CI:1.312~10.939,P=0.020)、入院时美国国立卫生研究院卒中量表(NIHSS)评分(OR=3.788,95%CI:1.312~10.939,P=0.013)是老年颅内大血管急性闭塞患者短期内发生HT的独立危险因素,Alberta卒中项目早期CT评分(OR=0.107,95%CI:0.012~0.898,P=0.039)是其保护因素。结论 发病至血管再通时间长、溶栓前血浆凝血酶原时间>16 s、病变位置为前循环、入院时NIHSS评分是老年颅内大血管急性闭塞患者短期内发生HT的主要危险因素。

Objective To investigate the risk and related risk factors of short-term hemorrhagic transformation(HT)in elderly patients with acute occlusion of large intracranial vessels.Methods A total of 143elderly patients with acute occlusion of intracranial large vessels admitted to Hebei Petro China Central Hospital and the First Medical Center of Chinese PLA General Hospital from January 2017to December 2021were retrospectively recruited,and then divided into HT group(n=43)and non-HT group(n=100)according to whether HT occurred within 90dafter onset.Their clinical data were compared,and analyzed with multivariate logistic regression analysis.Results Multivariate logistic regression analysis indicated that delayed vascularization(OR=5.088,95%CI:1.050-24.650,P=0.043),plasma prothrombinase time before thrombolysis>16s(OR=4.977,95%CI:1.126-21.992,P=0.034),anterior circulation occlusion(OR=3.629,95%CI:1.059-12.427,P=0.040),cardiogenic embolism(OR=3.788,95%CI:1.312-10.939,P=0.020),and high NIHSS score(OR=3.788,95%CI:1.312-10.939,P=0.013)were independent risk factors for short-term HT in elderly patients with acute intracranial large vessel occlusion,while high Alberta stroke program early CT score(OR=0.107,95%CI:0.012-0.898,P=0.039)was a protective factor.Conclusion Delayed vascularization,plasma prothrombin time before thrombolytic>16s,anterior circulation and high NIHSS score are the main risk factors for short-term HT in elderly patients with acute occlusion of large intracranial vessels.