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目的探讨急性脑梗死自发性出血转化(HT)的相关危险因素。方法对北京市海淀医院神经内科2011年6月至2014年12月收治的409例未溶栓治疗的脑梗死患者进行研究;其中HT组42例,非HT组367例。回顾性分析2组患者的临床指标,筛选急性脑梗死自发性HT的相关危险因素。结果 HT组患者脑白质病变、卒中史、糖尿病、高血压、心房颤动(房颤)、大面积脑梗死的发生率及24 h收缩压变异系数(CV)、舒张压CV水平均高于对照组(P<0.05)。logistic回归分析显示,脑白质病变(OR=1.794,95%CI 1.086~2.593,P=0.005)、房颤(OR=1.811,95%CI1.122~9.819,P=0.018)、大面积脑梗死(OR=6.527,95%CI 3.998~9.901,P=0.000)、收缩压CV(OR=1.994,95%CI1.158~4.876,P=0.022)、舒张压CV(OR=3.014,95%CI 2.121~5.032,P=0.008)是急性脑梗死自发性HT的独立危险因素。结论脑白质病变、房颤、脑梗死面积和血压变异性是急性脑梗死自发性HT的独立危险因素,能够预测自发性HT的发生。
Objective To explore the related risk factors of spontaneous hemorrhagic transformation (HT) in acute cerebral infarction. Methods 409 patients with cerebral infarction without thrombolysis treated in Department of Neurology, Haidian Hospital of Beijing from June 2011 to December 2014 were studied. Among them, 42 cases in HT group and 367 cases in non-HT group. The clinical data of two groups of patients were retrospectively analyzed to screen the relevant risk factors of spontaneous HT in acute cerebral infarction. Results The incidence of white matter lesions, stroke, diabetes mellitus, hypertension, atrial fibrillation and large area cerebral infarction in HT group were significantly higher than those in control group (P <0.05). Logistic regression analysis showed that white matter lesions (OR = 1.794,95% CI 1.086-2.593, P = 0.005), atrial fibrillation (OR = 1.811,95% CI 1.122-9.819, P = 0.018), large area cerebral infarction (OR = 6.527, 95% CI 3.998-9.901, P = 0.000), systolic blood pressure CV (OR = 1.994,95% CI 1.158-4.876, P = 0.022) 5.032, P = 0.008) were independent risk factors of spontaneous HT in acute cerebral infarction. Conclusions Leukoaraiosis, atrial fibrillation, infarct size and blood pressure variability are independent risk factors of spontaneous HT in acute cerebral infarction, and can predict the occurrence of spontaneous HT.