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目的探讨急性脑梗死的出血性转化的危险因素。方法收集2012年1月~2015年1月在湖北省恩施州利川市人民医院神经内科住院的急性脑梗死患者的临床及实验室检查资料,并在入院后10 d内行头颅CT复查,采用多变量logistic回归分析确定出血性转化的独立危险因素。结果共纳入345例急性脑梗死患者,其中男205例,女140例,101例发生出血性转化。出血性转化组的年龄、脑梗死体积、脑卒中史或TIA史、高血压病、糖尿病、抗凝药和房颤的比例均显著高于非出血性转化组(P<0.05),而2组抗血小板聚集药、他汀类、高脂血症史、吸烟或饮酒史无明显差异(P>0.05)。多变量logistic回归分析显示年龄(OR=1.168,95%,CI=1.059~3.412;P=0.021)、梗死体积(OR=3.461,95%C1=1.317~6.270;P=0.044)和房颤(OR=1.284,95%C1=1.117~2.903;P=0.015)为出血性转化的独立危险因素。结论急性脑梗死患者出血性转化的发生率为29.3%,年龄、脑梗死体积和房颤为出血性转化的独立危险因素,绝大多数出血性转化不会加重临床症状,临床症状加重的患者主要是脑实质血肿型。
Objective To investigate the risk factors of hemorrhagic transformation in acute cerebral infarction. Methods The clinical and laboratory data of patients with acute cerebral infarction hospitalized in the Department of Neurology, Icheon People’s Hospital, Enshi, Hubei Province from January 2012 to January 2015 were collected and examined by skull CT within 10 days after admission. Multivariate Logistic regression analysis identified independent risk factors for hemorrhagic transformation. Results A total of 345 patients with acute cerebral infarction were included, including 205 males and 140 females, with hemorrhagic transformation in 101 cases. Hemorrhagic transformation group of age, volume of cerebral infarction, history of stroke or history of TIA, hypertension, diabetes, anticoagulation and atrial fibrillation were significantly higher than non-hemorrhagic transformation group (P <0.05), while 2 Anti-platelet aggregation drugs, statins, history of hyperlipidemia, smoking or drinking history no significant difference (P> 0.05). Multivariate logistic regression analysis showed that age (OR = 1.168,95%, CI = 1.059-3.412; P = 0.021), infarct volume (OR = 3.461,95% CI = 1.317-6.270; = 1.284, 95% C1 = 1.117-2.903; P = 0.015) were independent risk factors for hemorrhagic transformation. Conclusions The incidence of hemorrhagic transformation in patients with acute cerebral infarction is 29.3%. Age, infarct volume and atrial fibrillation are independent risk factors for hemorrhagic transformation. Most hemorrhagic transformation does not aggravate clinical symptoms, and patients with worsening clinical symptoms mainly Is the brain parenchymal hematoma type.