超早期脑梗死患者溶栓后出血性转化危险因素分析

Analysis of Risk Factors for Hemorrhagic Transformation after Thrombolysis in Patients with Ultra-early Cerebral Infarction

目的:分析超早期脑梗死患者溶栓后出血性转化的危险因素。方法:选取2021年1月—2023年12月于吴川市人民医院接受溶栓治疗的超早期脑梗死患者377患者作为研究对象,根据溶栓后24h内出血性转化发生情况分为出血组(31例)和未出血组(346例)。分析两组临床资料,使用Logistic回归分析超早期脑梗死患者溶栓后出血性转化的危险因素。结果:超早期脑梗死患者377例溶栓后24 h内出现出血性转化31例(包括症状性出血11例,非症状性出血20例)。两组年龄,美国国立卫生院卒中量表(NIHSS)评分,格拉斯哥昏迷指数,梗死灶最大直径,合并糖尿病、合并心房颤动、合并高血压、有吸烟史占比,D-二聚体(D-D)、S100β蛋白、胶质纤维酸性蛋白(GFAP)、金属基质蛋白酶-9(MMP-9)水平存在显著差异(P<0.05)。Logistic回归分析结果显示,NIHSS评分高、梗死灶最大直径大、合并糖尿病、合并心房颤动及D-D、S100β蛋白、GFAP、MMP-9水平高是超早期脑梗死患者溶栓后出血性转化危险因素(P<0.05)。结论:超早期脑梗死患者溶栓后出血性转化的危险因素较多,临床应积极采取相应的预防措施。

Objective:To analyze the risk factors of hemorrhagic transformation after thrombolysis in patients with ultra-early cerebral infarction.Methods:A total of three hundred and seventy-seven patients with ultra-early cerebral infarction who received thrombolytic therapy in Wuchuan People's Hospital from January 2021 to December 2023 were selected as the study objects.According to the occurrence of hemorrhagic transformation within 24 h after thrombolysis,the patients were divided into bleeding group(31 cases)and non-bleeding group(346 cases).The clinical data of the two groups were analyzed and the risk factors of hemorrhagic transformation after thrombolysis in patients with ultra-early cerebral infarction were analyzed by Logistic regression.Results:Thirty-one cases of 377 patients with ultra-early cerebral infarction showed hemorrhagic transformation within 24 h after thrombolysis(including 11 cases of symptomatic hemorrhage and 20 cases of non-symptomatic hemorrhage).There were significant differences in age,national institutes of health stroke scale(NIHSS)score,Glasgow coma index,the largest diameter of the infarct,the proportion of patients with diabetes,atrial fibrillation,hypertension,smoking history,D-dimer(D-D),S100βprotein,glial fibrillary acidic protein(GFAP),and matrix metalloproteinase-9(MMP-9)between the two groups(P<0.05).Logistic regression analysis showed that high NIHSS score,large maximum diameter of infarction,high levels of diabetes mellitus,atrial fibrillation and D-D,S100βprotein,GFAP and MMP-9 were risk factors for hemorrhagic transformation after thrombolysis in patients with extremely early cerebral infarction(P<0.05).Conclusion:There are many risk factors of hemorrhagic transformation after thrombolysis in patients with ultra-early cerebral infarction,and corresponding preventive measures should be taken actively in clinic.