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目的回顾性分析合并脑微出血(cerebral microbleed,CMB)对溶栓治疗缺血性脑卒中后出血性转化(hemorrhagic transformation,HT)的相关性。方法回顾性分析2014-10/2016-09月在作者医院急诊科及神经内科住院、资料完整,并给予阿替普酶溶栓治疗急性缺血性脑卒中共97例患者的临床资料,以是否发生HT分为HT组(n=29)和非HT组(n=68),对核磁共振成像(magnetic resonance imaging,MRI)检测的CMB数量进行统计分析。结果溶栓前两组患者的美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分分别为(17.21±4.11)、(13.46±2.77)分,组间比较差异具有统计学意义(P<0.05)。HT组与非HT组比较,患者的年龄,糖尿病、高血压、心房纤颤等发生率均显著高于非HT组,组间比较差异具有统计学意义(P<0.05);多元logistic回归分析显示,中重度CMB、心源性脑栓塞、基线NIHSS评分是急性缺血性脑卒中溶栓治疗后出血转化的独立危险因素。结论中重度CMB是急性缺血性脑卒中溶栓治疗后HT的独立危险因素。
Objective To retrospectively analyze the correlation between cerebral microbleed (CMB) and thrombolytic therapy for hemorrhagic transformation (HT) after ischemic stroke. Methods The clinical data of 97 hospitalized patients with acute ischemic stroke treated with alteplase thrombolytic therapy in the emergency department and neurology department of the author hospital from January 2014 to September 2016 were retrospectively analyzed. The occurrence of HT was divided into HT group (n = 29) and non-HT group (n = 68). Statistical analysis was performed on the number of CMB detected by magnetic resonance imaging (MRI). Results The National Institutes of Health Stroke Scale (NIHSS) scores of the two groups before the thrombolysis were (17.21 ± 4.11) and (13.46 ± 2.77), respectively, with significant difference between the two groups (P <0.05). Compared with non-HT group, the incidence of age, diabetes mellitus, hypertension and atrial fibrillation in HT group was significantly higher than that in non-HT group (P <0.05). Multivariate logistic regression analysis , Moderate-severe CMB, cardiogenic cerebral embolism, baseline NIHSS score is an independent risk factor for hemorrhage after thrombolytic therapy in acute ischemic stroke. Conclusions Moderate to severe CMB is an independent risk factor for HT after thrombolytic therapy in acute ischemic stroke.