Evidence and thinking on risk factors of hypertensive intracerebral hemorrhage: a meta-analysis

Background:To explore the related risk factors of hypertensive intracerebral hemorrhage(ICH)through meta-analysis,and to provide evidence-based medical basis for preventing ICH in hypertensive patients.Methods:The databases of CNKI,Wanfang,VIP,CBM,PubMed,Web of Science and Cochrane Library were searched by computer.Case control study on risk factors for hypertensive intracerebral hemorrhage were collected from the database establishment to October 2021.Two reviewers independently screened the literature,extracted the data,and evaluated the bias risk of the included studies.Meta-analysis was conducted on the results of the included studies using RevMan5.3 software.Results:A total of 7 studies were included,including 1512 patients.Meta-analysis results showed that:Smoking history(OR=6.23,95%CI(4.32,8.99),P<0.00001),drinking history(OR=7.24,95%CI(1.96,26.72),P=0.003),diabetes mellitus(OR=47.52,95%CI(10.31,219.31),P<0.00001),coronary heart disease(OR=9.90,95%CI(2.96,33.13),P=0.0002),daily salt intake(OR=10.21,95%CI(2.69,38.79),P=0.0006),failure to take medication regularly on time(OR=10.62,95%CI(5.40,20.91),P<0.00001),total cholesterol(OR=6.58,95%CI(2.45,17.65),P=0.0002),triglyceride(OR=8.63,95%CI(6.70,11.12),P<0.00001),body mass index(OR=6.63,95%CI(4.56,9.64),P<0.00001)and experiencing severe economic difficulties(OR=23.97,95%CI(14.82,38.77),P<0.00001)were risk factors for hypertensive intracerebral hemorrhage.Conclusion:Controlling smoking,drinking,reducing daily salt intake,controlling body weight,preventing diabetes and coronary heart disease,low-fat diet,controlling total cholesterol and triglyceride,taking antihypertensive drugs regularly and improving economic status can prevent hypertensive cerebral hemorrhage.

Risk factors for intracerebral hemorrhage and coronary heart diseases over a 3-year period in patients admitted to some hospitals of Tongliao city of Nei Monggol Autonomous Region Retrospective analysis on case data

BACKGROUND： Intracerebral hemorrhage（ICH） and coronary heart disease （CHD） have the same pathological base, atherosclerosis, and the similar risk factors,such as smoking ,drinking, hypertension, hyperlipemia, diabetes mellitus, etc; but the distributions of two diseases are very different in the populations. This may be related to the exposure of risk factors and different effects of risk factors on two diseases. OBJECTIVE： To analyze the distribution difference of risk factors for ICH and CHD in the populations of Tongliao city of Nei Monggol Autonomous Region. DESIGN： Retrospective analysis. SETTING： School of Radiation Medicine and Public Health, Soochow University; Tongliao Hospital, Nei Monggol Autonomous Region. PARTICIPANTS： Random sampling was used to select 6 hospitals from 10 hospitals affiliated to Tongliao City of Nei Monggol Autonomous Region. Totally 1 672 medical records of patients with ICH and 2 195 medical records of patients with CHD admitted to Department of Neurology and Department of Cardiovascular Internal Medicine of above-mentioned 6 hospitals between January 2003 and December 2005 were collected according to the investigation need. METHODS： The subjects, whose medical records were involved, were performed retrospective analysis with pre-prepared questionnaire ＂Stroke and Coronary Heart Disease Epidemiologic Questionnaire＂. The main contents included： ①Social demography condition： The distributions of gender, age, nationality, etc. ②Previous history of disease： hypertension, diabetes mellitus, etc. ③Related risk factors： systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, smoking, drinking and glucose （GLU）. The database of Epidata was transformed to SPSS database. Single-and multiple-factor non-conditional Logistic regression analysis were performed on the data, and OR value and 95% CI were calculated. The distribution differences of risk factors for two diseases were compared. MAIN OUTCOME MEASURES： Single- and multi-factor non-conditional Logistic regression analysis results of each factor of patients. RESULTS： Single-factor non-conditional Logistic regression analysis showed that statistical significance existed in gender, age, nationality, smoking, drinking, history of hypertension, history of diabetes mellitus, hypertension, triglyceride （TG）, and GLU ten factors（OR =0.199, OR 95% CI 0.142-0.280 to OR =7.484, OR 95% CI 6.186-9.054, P 〈 0.01）. ②The results of multiple-factor non-conditional Logistic regression analysis showed 8 factors including age, gender, smoking, hypertension, history of hypertension, history of diabetes mellitus, GLU and TG（OR =0.203, OR 95% CI 0.114-0.361 to OR =8.262,OR 95% CI 5.466- 12.491, P 〈 0.01）. CONCLUSION： ICH and CHD are the diseases induced by various risk factors. Significant difference exists in gender, age, smoking, hypertension, history of hypertension, GLU, history of diabetes mellitus and TG.

Analysis on Risk Factors for Recurrent Hemorrhage after Surgery for Hypertensive Cerebral Hemorrhage

Objectives To analyze the risk factors for recurrent hemorrhage after craniotomy for hypertensive cerebral hemorrhage （HCH）. Methods Clinical data from 162 HCH patients who underwent surgery were retrospectively analyzed for the correlation between recurrent hemorrhage and gender, age, duration of hypertension, history of diabetes mellitus and hypercholesterolemia, site and volume of hemorrhage and post-surgical systolic and diastolic pressure. Results Post-surgical recurrent hemorrhage was found in 24 patients. With multi-variate regression analysis, history of diabetes, long-term hypertension and higher post-surgical systolic pressure were proved positively correlated to the incidence of recurrent hemorrhage after craniotomy for hypertensive cerebral hemorrhage （ P 〈 0.05 ）. Conclusions Risk factors for recurrent hemorrhage after craniotomy for hypertensive cerebral hemorrhage are history of diabetes, long-term hypertension and higher post-surgical systolic pressure. Patients with diabetes and hypertension are at higher risk for cerebral hemorrhage or post-surgical recurrent hemorrhage. Effective control on blood pressure after surgery can reduce the incidence of recurrent hemorrhage after surgery for hypertensive cerebral hemorrhage. （ S Chin J Cardiol 2009 ; 10 （4） ： 204 -207）

Factors associated with delayed intracerebral hemorrhage after superficial temporal artery-middle cerebral artery bypass in stenoocclusive cerebrovascular diseases

Background Intra-cerebral hemorrhage （ICH） is a devastating complication that can result from superficial temporal artery-middle cerebral artery （STA-MCA） bypass in patients undergoing treatment for steno-occlusive cerebrovascular disease （CVD）.There is a clinical need to find the possible risk factors to prevent ICH,as it is a significant cause of mortality and morbidity.The aim of the study was to investigate the factors associated with delayed ICH after STA-MCA bypass in patients with steno-occlusive CVDs.Methods We retrospectively analyzed the records of 163 patients seen from 2002 to 2011 with STA-MCA bypass for steno-occlusive cerebrovascular diseases at the Department of Neurosurgery,Xuan Wu Hospital,Beijing.Demographic and clinical data,including age,gender,vascular risk factors,preoperative syndrome,preoperative National Institutes of Health Stroke Scale （NIHSS）,ipsilateral ischemic lesions,classification of steno-occlusive CVDs,donor branches of STA,graft patency,postoperative hypertension,and postoperative-increased MCA velocity were recorded and analyzed.Binary Logistic regression served to identify factors associated with delayed ICH after STA-MCA bypass.Results We identified 8 （4.9%） patients with delayed ICH after STA-MCA bypass.Patients with hypertension,preoperative stroke,ipsilateral ischemic lesions,postoperative hypertension and postoperative-increased MCA velocity were significantly more prone to experiencing delayed ICH after STA-MCA bypass.Logistic regression analysis shows ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity remained independent predictors for delayed ICH after STA-MCA bypass.Conclusion Despite the varied associated factors in patients with steno-occlusive CVDs,ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity could be associated with delayed ICH after STAMCA bypass.

自发性脑出血继发脑室出血预后相关危险因素的Meta分析

目的 了解中国自发性脑出血继发脑室出血人群预后相关的影响因素。方法 检索PubMed、Embase、Cochrane Library、万方、中国知网、维普数据库中有关自发性脑出血继发脑室出血病例预后分析的队列研究,检索时限为从1990年1月1日—2023年6月18日,最终共纳入11项非随机病例对照研究,共计944例自发性脑出血继发脑室出血患者,包括583例预后良好和361例预后不良的患者。采用Newcastle-Ottawa量表评估质量,RevMan 5.4.0软件进行Meta分析。结果 患者发病时意识障碍(OR=7.38,95%CI=4.91~11.09,P<0.00001)、年龄(OR=2.66,95%CI=1.57~4.51,P=0.0003)、出血量(OR=8.45,95%CI=4.95~14.41,P<0.00001)、出血部位(OR=10.18,95%CI=3.43~30.20,P<0.0001)、入院血糖(OR=5.76,95%CI=2.87~11.54,P<0.00001)、中线有无移位(OR=4.67,95%CI=2.50~8.72,P<0.00001)、破入脑室的部位(OR=3.80,95%CI=2.38~6.08,P<0.00001)、范围(OR=0.18,95%CI=0.08~0.40,P<0.0001)和程度(OR=9.34,95%CI=5.10~17.13,P<0.00001)、瞳孔改变(OR=191.67,95%CI=36.44~1008.04,P<0.00001)、脑膜刺激征(OR=9.76,95%CI=4.09~23.25,P<0.00001)、治疗方案(OR=0.31,95%CI=0.15~0.64,P=0.02)、脑室铸型(OR=8.01,95%CI=3.09~20.76,P<0.0001)是继发脑室出血患者预后不良的危险因素。结论 发病时意识障碍、年龄>70岁、出血量≥20 ml、脑干出血、入院时血糖值高、中线有移位、3、4脑室受累、破入脑室范围广、双瞳孔不等大、有脑膜刺激征、脑室铸型、采用内科治疗方案是发生SIVH预后不良的危险因素,能够为SIVH预防决策的制定提供循证依据。

特发性血小板减少性紫癜患者脑出血危险因素的Meta分析

目的系统评价特发性血小板减少性紫癜患者脑出血的危险因素,为临床制定预防性干预措施提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普数据库、中国生物医学文献数据库、PubMed、Embase及Cochrane Library中有关特发性血小板减少性紫癜患者脑出血危险因素的相关研究,检索时限为建库至2022年12月。采用RevMan 5.3软件进行Meta分析。结果最终纳入6篇文献,Meta分析结果显示:头部创伤[OR=0.11,95%CI(0.05,0.14)]、使用抗凝抗血小板药物[OR=0.07,95%CI(0.04,0.10)]、入院30 d内有感染病史[OR=0.16,95%CI(0.12,0.21)]、合并高血压[OR=0.13,95%CI(0.08,0.18)]、糖尿病[OR=0.12,95%CI(0.08,0.16)]、血小板计数<10×10^(9)/L[OR=0.49,95%CI(0.44,0.54)]以及有严重出血病史[OR=0.62,95%CI(0.56,0.69)]是特发性血小板减少性紫癜患者脑出血的危险因素。结论特发性血小板减少性紫癜患者脑出血的危险因素较多,医护人员需结合患者实际情况全面评估其脑出血风险,尽早给予个体化的干预手段,以降低特发性血小板减少性紫癜患者脑出血的发生风险。

高血压脑出血术后肺部感染的危险因素Meta分析

目的:分析高血压脑出血术后肺部感染危险因素。方法:检索中国知网、万方、维普、PubMed、EMBASE、Web of Science和Cochrane Library有关危险因素相关研究。检索时限从建库至2024年4月,筛选符合要求的文献,并进行质量评价和提取相比值比(OR)及95%CI,采用RevMan5.4软件进行Meta分析。结果:有13篇文献符合要求,共计689例高血压脑出血患者。通过Meta分析后认为危险因素包括吸烟史、糖尿病、低蛋白血症、机械通气时间、侵入性操作、气管切开、GCS<8、鼻饲;描述性分析结果显示:年龄、GCS与术后发生肺部感染有关。结论:高血压脑出血肺部感染危险因素较多,尽早识别危险因素,采取相关防治措施,有利于降低肺部感染发病率。

高血压脑出血血肿灶PAF NO ET的变化研究及临床意义

目的探讨高血压脑出血血肿局部血小板激活因子(PAF)、一氧化氮(NO)、内皮素(ET)的水平变化及临床意义。方法采用放射免疫法和酶联免疫吸附法动态监测68例轻、中、重度高血压脑出血血肿灶冲洗液中PAF、NO、ET的水平变化。结果高血压脑出血发病4 h血肿冲洗液中已检测出PAF,轻型组患者PAF于24 h达高峰,之后逐渐降低,中、重度组患者PAF于24-48 h达高峰。NO、ET出现于脑出血后12 h,并随病情变化呈现不同变化趋势。结论脑出血后血肿灶PAF、NO、ET水平的变化与疾病的转归密切相关。

高血压脑出血患者血清TNF-α、VEGF、ET-1水平的变化及意义

目的:探讨高血压脑出血(hypertensive cerebral hemorrhage,HICH)患者血清肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)和内皮素-1(ET-1)水平的变化及临床意义。方法:采用ELISA法检测HICH患者及健康体检者血清TNF-α、VEGF和ET-1的水平,并分析不同GCS评分HICH患者血清TNF-α、VEGF和ET-1水平的变化情况。结果:HICH患者血清TNF-α、VEGF和ET-1水平均明显高于健康体检者(P<0.05)。并且,随着HICH患者GCS评分的降低,血清TNF-α、VEGF和ET-1水平逐渐升高(P<0.05)。结论:检测HICH患者血清TNF-α、VEGF和ET-1水平,对于HICH患者病情和预后判断有重要意义。

血清ET-1水平与动脉瘤性蛛网膜下腔出血后迟发性脑缺血的关系

目的探讨血清内皮素-1(ET-1)水平对动脉瘤性蛛网膜下腔出血(aSAH)后迟发性脑缺血(DCI)的预测效能。方法回顾性分析2019年9月至2023年1月收治的104例aSAH的临床资料。DCI定义为在排除手术相关脑缺血后,第3~14天出现CT低密度或相应的MRI表现。采用ELISA法检测入院时血清ET-1水平。结果104例中,39例(37.50%)发生DCI。多因素logistics回归分析显示血清ET-1水平增高为DCI的独立危险因素(OR=9.784;95%CI 3.458~27.688;P<0.001)。ROC曲线分析显示,血清ET-1水平预测DCI的曲线下面积为0.840(95%CI 0.764~0.917),最佳截断值为33.25 pg/ml,灵敏度及特异度分别为79.5%、76.9%。结论aSAH后血清ET-1水平升高,监测血清ET-1水平变化,可预测DCI的发生风险。

动脉瘤性蛛网膜下腔出血致迟发性脑血管痉挛危险因素的Meta分析

目的运用Meta分析方法综合分析动脉瘤性蛛网膜下腔出血致迟发性脑血管痉挛(DCVS)的相关危险因素,为疾病的预防、治疗决策提供依据。方法用关键词途径从维普中文科技期刊、中国知网和万方以及Pubmed、Springlink和Highwire等外文数据库收录有关动脉瘤性蛛网膜下腔出血致DCVS相关危险因素的文献进行检索,经严格筛选后对最后纳入的文献用RevMan5.1软件进行Meta分析。结果共纳入13篇文献,经检验所有数据均均衡,采用固定效应模式进行Meta分析。高血压病史、Fisher分级(>2级)、年龄(>50岁)、动脉瘤位置(后循环)差异有统计学意义(P<0.05),性别(男性)、吸烟史、手术方式(夹闭)差异无统计学意义(P>0.05)。数据漏斗图分析对称,提示文献无发表偏倚。结论有高血压病史、Fisher分级(>2级)、年龄(<50岁)、动脉瘤位置(后循环)的患者更易发生DCVS,临床上应对此类患者加强监测与管理。

急性脑梗死rt-PA静脉溶栓后出血性转化危险因素的meta分析

目的系统评价急性脑梗死rt-PA静脉溶栓后出血性转化的相关危险因素。方法计算机检索PubMed、Web of Science、The Cochrane Library、EMbase、CBM、CNKI、WanFang Data、VIP数据库,搜集与急性脑梗死rt-PA静脉溶栓后出血性转化危险因素相关的队列研究或病例-对照研究,检索时限从2010年1月~2020年1月,由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用Rev Man 5.1软件进行meta分析。结果共纳入32个研究,包括1352例患者。meta分析结果显示:大面积脑梗死[OR=4.50,95%CI:1.77~11.47],脑白质疏松[OR=2.91,95%CI:1.68~5.02],溶栓前血糖[OR=3.44,95%CI:2.46~4.81],溶栓后收缩压[OR=2.39,95%CI:1.44~3.96],发病至溶栓时间[OR=2.47,95%CI:1.24~4.91],NIHSS评分[OR=1.11,95%CI:1.08~1.14],房颤[OR=2.80,95%CI:2.13~3.67],是急性脑梗死rt-PA静脉溶栓后出血性转化的危险因素。血尿酸[OR=0.99,95%CI:0.98~1.00]是急性脑梗死rt-PA静脉溶栓后出血性转化的保护因素。结论此次meta分析表明了8项研究因素与急性脑梗死rt-PA静脉溶栓后出血性转化相关,考虑到偏倚存在的可能性,应谨慎解释上述结果,不应让其成为阻止溶栓的理由。

非溶栓急性脑梗死患者出血转化相关危险因素的Meta分析

目的通过Meta分析研究非溶栓急性脑梗死患者出血转化(HT)相关危险因素,为临床上早期识别、预防提供循证医学依据。方法检索PubMed、EMBASE、the Cochrane Library、CNKI、万方、维普、CBM数据库,筛选非溶栓急性脑梗死患者HT相关危险因素的文献,运用Revman 5.3和Stata 14软件对纳入的文献进行Meta分析。结果纳入的16项研究中总样本量7045例,HT组986例,非HT组6059例。Meta分析各危险因素的合并OR值及95%CI分别为:男性0.81(0.68,0.96),年龄0.70(-0.16,1.55),心房颤动3.35(2.25,4.48),高血压0.82(0.67,1.01),糖尿病1.23(0.96,1.52),高脂血症1.24(0.53,2.91),卒中史1.33(0.98,1.79),饮酒史1.30(0.84,1.99),吸烟史1.92(1.19,3.10),抗血小板治疗0.67(0.29,1.56),抗凝治疗2.18(1.15,4.12),大面积梗死4.08(2.40,6.94),血糖1.08(0.67,1.49),收缩压7.07(-3.51,17.55),舒张压0.61(-1.26,2.49),总胆固醇-0.17(-0.31,-0.03),三酰甘油-0.12(-0.21,-0.04),低密度脂蛋白-0.01(-0.21,0.18),高密度脂蛋白0.04(0.01,0.08),血小板计数4.93(-18.44,28.31),NIHSS评分2.94(1.41,4.47)。结论心房颤动、大面积梗死、吸烟、抗凝治疗及NIHSS评分为非溶栓急性脑梗死患者HT的危险因素。男性、高密度脂蛋白、总胆固醇及三酰甘油为非溶栓急性脑梗死患者HT的保护性因素。年龄、高血压、糖尿病、卒中史、高脂血症、低密度脂蛋白、血糖、收缩压、舒张压、饮酒、抗血小板治疗及血小板计数与非溶栓急性脑梗死患者HT无关。

Severe pathological manifestation of cerebral amyloid angiopathy correlates with poor outcome from cerebral amyloid angiopathy related intracranial hemorrhage

Background Cerebral amyloid angiopathy （CAA） is one of the main causes of spontaneous intracranial hemorrhage （ICH）. No established link is available between pathological scores of CAA and its outcome. This study aimed to identify the correlations between pathological severity and poor postoperative outcome in the Chinese population. Methods Between May 2006 and April 2011, 367 consecutive patients who underwent surgery for CAA-related ICH in 71 hospitals throughout the mainland of China were enrolled in this study. Twelve months after surgery, we evaluated these patients＇ outcomes according to the modified Rankin Scale （mRS） and statistically correlated risk factors （demographics, medical history, pathological results, and surgical details） that are associated with a favorable （mRS 〈3） and poor （mRS 〉3） outcome groups. Results Risk factors for poor postoperative outcome in 367 patients with CAA-related ICH included advanced age （OR 1.034, 95% CI 1.001-1.067, P=0.042）, CAA pathology severity （OR 2.074, 95% CI 7.140-16.25, P 〈0.001）, lobar hematoma （OR 0.225, 95% CI 0.104-0.486, P 〈0.001）, presence of intraventricular hemorrhage （OR 0.478, 95% CI 0.229-1.001, P=0.050）, and/or subarachnoid hemorrhage （OR 2.629, 95% CI, 1.051-6,577, P=0.039）. Conclusions Poor postoperative outcome of patients with CAA-related ICH was more related to the severe pathological manifestation instead of other factors. Prior ischemia may present an early stage of CAA.

老年急性脑出血患者并发低钾血症的相关危险因素及风险预测模型构建

目的 探讨老年急性脑出血患者并发低钾血症的相关危险因素,并且基于logistic回归构建风险预测模型。方法 选取2022年6月至2024年5月佛山市中医院诊治的老年急性脑出血患者190例,根据有无并发低钾血症分为低钾血症组(血钾<3.5 mmol/L)51例和正常组(血钾3.5~5.5 mmol/L)139例。采用logistic回归分析影响急性脑出血患者并发低钾血症的危险因素,并根据危险因素构建综合指数模型;ROC曲线分析综合指数预测急性脑出血患者并发低钾血症危险因素的诊断价值。结果 低钾血症组女性、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、入院时尿素、入院时血清肌酐、肾小球滤过率≤60 ml/min、呋塞米剂量>20 mg/d比例高于正常组(P<0.01)。单因素logistic回归分析显示,女性、入院时NIHSS评分、入院时尿素、入院时血清肌酐、肾小球滤过率≤60 ml/min、呋塞米剂量>20 mg/d为老年急性脑出血患者并发低钾血症的危险因素(P<0.05,P<0.01);多因素logistic回归分析显示,女性、入院时NIHSS评分、肾小球滤过率≤60 ml/min、呋塞米剂量>20 mg/d为老年急性脑出血患者并发低钾血症的危险因素(OR=6.393,95%CI:2.138~19.112,P=0.001;OR=3.123,95%CI:2.161~4.513,P=0.000;OR=3.327,95%CI:1.137~9.736,P=0.028;OR=3.111,95%CI:1.083~8.933,P=0.035)。ROC曲线分析显示,女性、入院时NIHSS评分、肾小球滤过率≤60 ml/min、呋塞米剂量>20 mg/d及综合指数预测急性脑出血患者并发低钾血症的曲线下面积分别为0.621、0.897、0.601、0.613、0.857,敏感性分别为52.90%、76.50%、49.00%、54.90%、72.50%,特异性分别为71.20%、88.50%、71.20%、67.60%、87.80%。结论 女性、入院时NIHSS评分、肾小球滤过率≤60 ml/min、呋塞米剂量>20 mg/d可能会对急性脑出血患者并发低钾血症产生影响,并依据这些危险因素构建综合指数模型对预测急性脑出血患者并发低钾血症具有较高的效能。

动脉瘤性蛛网膜下腔出血并发脑水肿的影响因素及预后分析

目的 探讨影响动脉瘤性蛛网膜下腔出血(subarachnoid hemorrhage, SAH)并发脑水肿的危险因素,并对患者生存预后进行分析。方法 选取动脉瘤性SAH患者315例为研究对象,根据是否发生脑水肿将患者分为脑水肿组(n=78)及未发生脑水肿组(n=237),采用Logistic回归分析影响患者并发脑水肿的危险因素;根据改良Rankin评分(Modified Rankin Scale, mRS)将患者分为预后良好组(n=42)及预后不良组(n=36),采用Logistic回归分析影响患者预后不良的因素。结果 年龄≥60岁、颅内感染为动脉瘤性SAH并发脑水肿的独立危险因素(P<0.05);随访1年,36例患者预后不良,年龄、Hunt-Hess分级、CT Fisher分级、病灶数目为动脉瘤性SAH并发脑水肿患者预后不良的独立影响因素(P<0.05)。结论 高龄、颅内感染的动脉瘤性SAH患者应密切注意脑水肿的发生。对于高龄、Hunt-Hess分级Ⅲ~Ⅳ级、CT Fisher分级4级、病灶多发患者应关注预后情况,防止预后不良的发生。

急性脑梗死机械取栓术后出血性转化的发生率及危险因素

目的探讨急性脑梗死(ACI)机械取栓术后出血性转化(HT)的发生率及危险因素。方法分析2022年1月至2023年12月梅州市人民医院接受机械取栓的125例ACI患者临床资料,统计ACI患者机械取栓后HT发生率。根据是否发生HT分为HT组和非HT组。分析机械取栓后发生HT的危险因素。结果125例ACI患者机械取栓后发生HT患者38例,发生率为30.4%。HT组年龄≥60岁、糖尿病、大面积脑梗死、美国国立卫生研究院卒中表评分(NIHSS)评分≥15分、取栓次数>2次患者比例高于非HT组(^(均)P<0.05),HT组患者外周血NLR水平高于非HT组(P<0.05)。多因素Logistic回归显示,年龄、糖尿病、大面积脑梗死、NIHSS评分≥15分、取栓次数>2次和外周血NLR≥5.73是ACI患者机械取栓后发生HT的重要危险因素(~均P<0.05)。根据多因素Logistic回归构建机械取栓后HT的预测模型,Logit(P)=-5.696+1.326×年龄+1.894×糖尿病+1.526×大面积脑梗死+2.243×NIHSS评分+3.610×取栓次数+2.660×NLR。该预测模型评估HT发生的受试者工作特征(ROC)曲线下面积为0.913(95%CI:0.861~0.965),敏感度为89.5%,特异度为80.5%。结论ACI患者机械取栓后HT发病率较高,年龄、糖尿病、大面积脑梗死、NIHSS评分、取栓次数和外周血NLR水平与ACI患者机械取栓后HT的发生有关,构建危险因素预测模型有助于早期评估HT发生风险。

超早期脑梗死患者溶栓后出血性转化危险因素分析

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。

基于GCS评分的Nomogram图预测急性脑出血后卒中相关性肺炎的发生风险

目的 通过构建Nomogram预测模型,探讨急性脑出血后发生卒中相关性肺炎(SAP)的危险因素。方法 回顾性分析2018-01—2022-12平顶山学院第一附属医院神经外科、重症医学科及神经重症的1 050例急性脑出血患者的临床资料,先根据GCS评分进行感染率的分层分析,然后运用组间差异性比较及多因素Logistic回归分析筛选SAP的独立危险因素,应用R语言构建Nomogram预测模型,并对构建的模型进行评价。结果 急性脑出血患者中SAP发生率为35.9%,其中GCS评分3~8分患者为77.21%,GCS评分9~12分患者为30.81%,GCS评分13~15分患者为6.50%,各组间感染率差异有统计学意义(P<0.05)。多因素Logistic回归显示,年龄、GCS评分、入院时随机血糖、淋巴细胞绝对值及手术治疗均为SAP独立危险因素,以这5个危险因素构建的Nomogram预测模型可帮助临床医师预测急性脑出血后SAP发生风险,具有较高的准确性和临床适用性。结论 基于GCS评分构建的Nomogram预测模型能够在疾病早期阶段准确高效地对急性脑出血患者发生SAP的风险进行分层,识别出易发生SAP患者的高风险人群,从而采取有针对性的干预措施。

自发性脑出血患者术后合并肺栓塞的预测模型的构建与验证

目的探讨自发性脑出血患者术后合并肺栓塞的危险因素,构建并验证列线图模型。方法本研究是回顾性队列研究,回顾性选取2015年1月至2023年1月于重庆医科大学附属第一医院及重庆大学附属三峡医院住院治疗的393例患者为训练组,165例患者为验证组,采用单因素和多因素逐步Logistic回归分析,筛选出与自发性脑出血术后合并肺栓塞相关的危险因素,构建并验证基于这些因素的列线图模型。结果基于年龄、出血量、格拉斯哥昏迷评分(Glasgow coma scale,GCS)、手术方式、纤维蛋白(原)降解产物(fibrinogen degradation product,FDP)、D-二聚体、血红蛋白和血浆、渗透压、有无深静脉血栓等危险因素绘制列线图模型,受试者工作特征曲线(receiver operating characteristic curve,ROC)显示模型对是否存在肺栓塞区分度良好,曲线下面积(area under curve,AUC)=0.908,验证集的Hosmer-Lemeshow拟合优度检验表明此模型对于验证集的拟合度良好(χ^(2)=14.805,df=8,P=0.063),校正曲线与理想曲线较为接近,模型的预测概率与实际发生概率接近,说明该模型准确性较高,决策曲线分析显示在较大范围的阈值概率下,建立的列线图模型均可获得收益。结论本研究建立的自发性脑出血患者术后合并肺栓塞的预测模型具有良好的预测性能,可在临床工作中准确、及时、快速识别肺栓塞的发生。