论文部分内容阅读
目的探讨脑梗死患者出血转化(HT)的危险因素。方法回顾性分析2008年8月—2011年8月南京医科大学附属杭州市第一人民医院神经内科收治的960例脑梗死患者的临床资料。根据是否发生HT,将其分为HT组(90例)及非HT组(870例)。观察两组患者入院24 h内的血压、餐后及空腹血糖、胆固醇水平,影像学监测到的梗死面积,心房颤动,溶栓治疗,入院前、后的抗凝治疗,既往抗血小板聚集治疗史。对差异有统计学意义的指标采用多因素Logistic回归方法确定HT的危险因素,并对比类肝素药物治疗急性缺血性卒中试验(TOAST)分型中各类型脑梗死HT的发生率。结果①多因素Logistic回归结果显示,大面积脑梗死(P=0.000,OR=10.519,95%CI:6.600～16.766)、心房颤动(P=0.006,OR=1.913,95%CI:1.206～3.003)、溶栓治疗(P=0.033,OR=2.502,95%CI:1.078～5.805)、抗凝治疗(P=0.000,OR=7.877,95%CI:2.491～25.911)、餐后血糖≥10 mmol/L或空腹血糖≥7.0 mmol/L(P=0.011,OR=0.822,95%CI:1.146～2.897)是HT的独立危险因素;收缩压≥180 mm Hg和(或)舒张压≥110 mm Hg、高胆固醇(5.98 mmol/L)以及抗血小板聚集史不是HT的独立危险因素。②TOAST分型中,心源性栓塞型脑梗死患者的HT发生率最高(21.4%,34/159),小动脉闭塞型脑梗死患者的HT发生率最低(1.1%,2/181),大动脉粥样硬化型脑梗死HT的发生率为8.6%(51/593)。结论大面积脑梗死、心房颤动、溶栓、抗凝、高血糖等是HT的独立危险因素。心源性栓塞型脑梗死是发生HT的重要原因之一。
Objective To explore the risk factors for hemorrhagic transformation (HT) in patients with cerebral infarction. Methods The clinical data of 960 patients with cerebral infarction admitted from the Department of Neurology, Hangzhou First People ’s Hospital affiliated to Nanjing Medical University from August 2008 to August 2011 were retrospectively analyzed. HT was divided into HT group (90 cases) and non-HT group (870 cases) according to whether HT occurred. Blood pressure, postprandial blood glucose, fasting blood glucose and cholesterol levels, infarct size monitored by imaging, atrial fibrillation, thrombolytic therapy, anticoagulant therapy before and after admission, and previous anti-platelet aggregation therapy . Multivariate Logistic regression was used to determine the risk factors for HT and the incidence of HT among various types of cerebral infarction in the classification of acute ischemic stroke (TOAST) was compared with those with statistically significant differences. Results ①Multi-factor Logistic regression analysis showed that large area cerebral infarction (P = 0.000, OR = 10.519, 95% CI 6.600 ~ 16.766), atrial fibrillation (P = 0.006, OR = 1.913, 95% CI 1.206-3.003) , Thrombolysis (P = 0.033, OR = 2.502, 95% CI: 1.078-5.805), anticoagulation therapy (P = 0.000, OR = 7.877, 95% CI: 2.491-25.911) L or fasting blood glucose≥7.0 mmol / L (P = 0.011, OR = 0.822, 95% CI: 1.146-2.897) was an independent risk factor for HT; systolic blood pressure ≥180 mm Hg and / or diastolic blood pressure ≥110 mm Hg, High cholesterol (5.98 mmol / L) and anti-platelet aggregation is not an independent risk factor for HT. ② In TOAST classification, the incidence of HT was the highest in patients with cardioembolic infarction (21.4%, 34/159), and the incidence of HT was the lowest in patients with arteriolar occlusive cerebral infarction (1.1%, 2/181) The incidence of HT in patients with sclerosing cerebral infarction was 8.6% (51/593). Conclusion Large area cerebral infarction, atrial fibrillation, thrombolysis, anticoagulation and hyperglycemia are independent risk factors of HT. Cardiac embolism cerebral infarction is one of the important causes of HT.