脑梗死后出血转化的危险因素分析

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摘要目的：探讨心源性脑梗死（CE）及大动脉粥样硬化性脑梗死（LAA）出血转化（HT）的相关危险因素。方法：回顾性分析2009年1月至2012年12月急性前循环脑梗死患者560例（其中CE组186例，LAA组374例），按是否发生HT分为HT亚组和非HT亚组。收集患者既往高血压病史、糖尿病病史及心房颤动病史，入院24 h内的血压、空腹血糖（FBG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、影像学检测到的梗死面积，入院后的抗凝、抗血小板及他汀类药物治疗情况。首先进行单因素分析，对差异有统计学意义的指标进行多因素Logistic回归分析，分别得出两种类型脑梗死HT的危险因素。结果：LAA组与CE组患者间HT的发生率差异有统计学意义（P=0.005，OR=1.946，95%CI：1.224～3.093）。多因素Logistic回归分析显示，在LAA组，他汀类药物治疗（OR=0.212，95%CI：0.067～0.672）、抗血小板治疗（OR=0.170，95%CI：0.074～0.388）及美国国立卫生院神经功能缺损评分（NIHSS）评分（OR=1.088，95%CI：1.02～1.16）与HT显著相关，而在CE组，FBG（OR=2.168，95%CI：1.131～4.155）和抗血小板治疗（OR=2.224，95%CI：1.142～4.330）为HT的独立危险因素。结论：CE患者较LAA患者HT发生率高。抗血小板治疗及他汀类药物治疗为LAA患者HT的保护因素，入院时NIHSS评分与LAA患者HT相关，而FBG高及抗血小板治疗为CE患者HT的危险因素。

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	兰清莲1
	周成业1
	王小同2

关键词 ：脑梗死, 出血转化, 危险因素

Abstract：Objective: To contrast the incidence of HT between large artery atherothrombosis (LAA) and cardioembolism (CE), and to investgate the risk factors for hemorhagic transformation (HT) in patients with anterior circulation infarction who was attributed to cardioembolism (CE) or large artery atherothrombosis (LAA). Methods: The clinical data of 560 acute ischemic stroke patients admitted to Wenzhou First Hospital Affiliated to Wenzhou Medical University between January 2010 and December 2012 were retrospectively collected. They were divided into HT group and non-HT group. Baseline demographic and clinical information collected included gender, age at onset, hypertension, diabetes, atrial fibrillation, systolic blood pressure and diastolic blood pressure levels, fasting blood glucose level, levels of TC and low-density lipoprotein cholesterol, National Institute of Health Stroke Scale (NIHSS) score at admission, infarct size, use of antiplatelet or anticoagulant medications and statins treatment. Univariate analysis was performed using idependent-Student’s t-tests (for continuous variables) and chi-square test (for categorical variables) for each of the predictors of interest. Subsequent multivariable modeling included the presence of HT as the dependent variable in stepwise logistic regression. Results: Statins use [odds ratio (OR)=0.212, 95% confidence interval (CI): 0.067-0.672], antiplatelet treatment (OR=0.170, 95%CI: 0.074-0.388) and the NIHSS score (OR=1.088, 95%CI: 1.02-1.16) were predictors of hemorrhagic transformation in LAA patients, while antiplatelet treatment (OR=2.224, 95%CI: 1.142-4.330) and blood glucose level (OR=2.168, 95%CI: 1.131-4.155) in CE patients. Conclusion: A higher HT rate found in the CE group than that in the LAA group. In LAA patients, statins used and antiplatelet treatment can lower the incidence of HT while NIHSS score may be a risk factor.But antiplatelet trentment and high blood glucose level may be the possible risk factors in CE patients.

Key words： brain infarction hemorhagic transformation risk factors

收稿日期: 2013-10-04

基金资助:温州市科技计划资助项目（Y20l00068）；温州市重大科研基金资助项目（Y20070038）。

通讯作者: 周成业，主任医师，硕士生导师，Emai1：zhoucy86＠126.com。

作者简介: 兰清莲（1987-），女，四川内江人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2014/V44/I12/877

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