静脉溶栓前脑白质疏松程度与AIS患者术后HT及短期预后的关系

Relationship Between the Degree of Leukoaraiosis Before Intravenous Thrombolysis and Postoperative HT,Short-term Prognosis in AIS Patients

目的探讨静脉溶栓前脑白质疏松程度对急性缺血性脑卒中(AIS)患者术后出血转化(HT)及短期预后的影响。方法纳入2016年1月-2021年12月于我院行静脉溶栓治疗的AIS患者共288例,根据是否发生HT和预后情况分别分为伴HT组(242例)和无HT组(46例),预后良好组(166例)和预后不良组(122例),比较伴HT组和无HT组、预后良好组和预后不良组的临床特征,评价术后HT及90 d预后不良与静脉溶栓前脑白质疏松程度的关系。结果伴HT组和无HT组中重度脑白质疏松患者比例、D-二聚体(D-D)水平及尿比重水平比较,差异有统计学意义(P<0.05);预后不良组和预后良好组年龄、基线美国国立卫生院神经功能缺损评分(NIHSS)、HT比例、基线随机血糖水平、国际标准化比值(INR)、急性卒中治疗Org10172试验(TOAST)分型、D-D,纤维蛋白原(FIB)、凝血酶原时间(PT)及尿糖阳性比例比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,是否合并中重度脑白质疏松和D-D水平是AIS患者静脉溶栓术后HT的独立影响因素(P<0.05);基线NIHSS评分和白血胞计数(WBC)是AIS患者静脉溶栓术后90 d预后不良的独立影响因素(P<0.05)。结论AIS患者静脉溶栓术后是否HT与合并中重度脑白质疏松和D-D水平密切相关;另外,基线NIHSS评分高和高WBC计数的患者往往提示短期预后不良。

Objective To investigate the effect of leukoaraiosis before intravenous thrombolysis on postoperative hemorrhagic transformation(HT)and short-term prognosis in patients with acute ischemic stroke(AIS).Methods A total of 288 AIS patients who underwent intravenous thrombolysis in our hospital from January 2016 to December 2021 were included.According to the occurrence of HT and prognosis,they were divided into HT group(242 patients)and non-HT group(46 patients),good prognosis group(166 patients)and poor prognosis group(122 patients).The clinical characteristics of HT group and non-HT group,good prognosis group and poor prognosis group were compared,and the relationship between postoperative HT,poor prognosis at 90 days and the degree of leukoaraiosis before intravenous thrombolysis was evaluated.Results There were significant differences in the proportion of patients with moderate to severe leukoaraiosis,D-dimer(D-D)level and urine specific gravity level between the HT group and the non-HT group(P<0.05).There were statistically significant differences in age,baseline National Institutes of Health Stroke Scale(NIHSS)score,HT ratio,baseline random blood glucose level,international normalized ratio(INR),acute stroke treatment Org10172 test(TOAST)classification,D-D,fibrinogen(FIB),prothrombin time(PT)and urine glucose positive ratio between the poor prognosis group and the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that moderate to severe leukoaraiosis and D-D level were independent influencing factors of HT in AIS patients after intravenous thrombolysis(P<0.05).Baseline NIHSS score and white blood cell count(WBC)were independent influencing factors of poor prognosis at 90 days after intravenous thrombolysis in AIS patients(P<0.05).Conclusion Whether HT after intravenous thrombolysis in AIS patients is closely related to moderate to severe leukoaraiosis and D-D level.In addition,patients with high baseline NIHSS score and high WBC count often indicate poor short-term prognosis.