急性脑梗死患者阿替普酶静脉溶栓后发生脑水肿的影响因素

Influencing factors of cerebral edema after intravenous thrombolysis with Alteplase in patients with acute cerebral infarction

目的:分析急性脑梗死(ACI)患者阿替普酶静脉溶栓后发生脑水肿的影响因素。方法:选取2019年7月至2022年7月该院收治的105例行阿替普酶静脉溶栓治疗的ACI患者进行前瞻性研究,静脉溶栓后3 d,统计ACI患者脑水肿发生情况,采用Logistic回归分析ACI患者阿替普酶静脉溶栓后发生脑水肿的影响因素。结果:静脉溶栓后3 d,105例ACI患者中发生脑水肿20例,占19.05%(20/105);发生脑水肿患者合并糖尿病、合并心房颤动、血管内皮生长因子(VEGF)水平≥142.2 pg/mL、肿瘤坏死因子-α(TNF-α)水平≥30 mg/L占比高于未发生脑水肿患者,差异有统计学意义(P<0.05);Logistic回归分析结果显示,合并糖尿病、合并心房颤动、血清VEGF水平≥142.2 pg/mL、血清TNF-α水平≥30 mg/L均为影响ACI患者阿替普酶静脉溶栓后发生脑水肿的危险因素(OR>1,P<0.05)。结论:合并糖尿病、合并心房颤动、血清VEGF水平≥142.2 pg/mL、TNF-α水平≥30 mg/L均为影响ACI患者阿替普酶静脉溶栓后发生脑水肿的危险因素。

Objective:To analyze influencing factors of cerebral edema after intravenous thrombolysis with Alteplase in patients with acute cerebral infarction(ACI).Methods:A prospective study was conducted on 105 patients with ACI who underwent intravenous thrombolytic therapy with Alteplase from July 2019 to July 2022.3 days after intravenous thrombolysis,the incidence of cerebral edema in these ACI patients was statistically analyzed.Logistic regression was used to analyze the influencing factors of cerebral edema after intravenous thrombolysis with Alteplase in the ACI patients.Results:3 days after intravenous thrombolysis,among the 105 patients,20 cases of cerebral edema occurred,accounting for 19.05%(20/105).The proportions of combined diabetes,combined atrial fibrillation,vascular endothelial growth factor(VEGF)≥ 142.2 pg/mL and tumor necrosis factor-α(TNF-α) ≥ 30 mg/L in the patients with cerebral edema were higher than those in the patients without cerebral edema,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that combined diabetes,combined atrial fibrillation,serum VEGF ≥ 142.2 pg/mL,and serum TNF-α≥ 30 mg/L were the risk factor for brain edema in the ACI patients after intravenous thrombolysis with Alteplase(OR1,P<0.05).Conclusions:Combined diabetes,combined atrial fibrillation,serum VEGF ≥ 142.2 pg/mL,and serum TNF-α≥ 30 mg/L are the risk factor for brain edema in the ACI patients after intravenous thrombolysis with Alteplase.