急性缺血性脑卒中患者溶栓后出血转化及预后相关危险因素的研究  

Study on risk factors related to hemorrhage transformation and prognosis in patients with acute ischemic stroke after thrombolysis

作　　者：刘伊妮 裴观辉 王怡冰 聂超 李海娜 许蕾[1] Liu Yini;Pei Guanhui;Wang Yibing;Nie Chao;Li Haina;Xu Lei(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《脑与神经疾病杂志》2020年第11期678-682,共5页Journal of Brain and Nervous Diseases

摘　　要：目的分析急性缺血性脑卒中(AIS)患者经重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗后出血转化(HT)及预后相关的危险因素。方法纳入2019年1月至2019年11月期间于河北医科大学第二医院神经内科确诊AIS并接受rt-PA静脉溶栓治疗的符合本研究纳入排除标准的住院患者。分析患者的一般临床资料和HT,评估发病7d和3个月的功能结局情况。结果①共纳入91例患者,有24例发生出血转化,发病后7d有43例预后良好,3个月有53例预后良好;②溶栓前NIHSS评分与7d预后的相关性有统计学意义(P<0.001);③心房颤动与HT的相关性有统计学意义(P=0.001);④性别(P=0.009)和溶栓前NIHSS评分(P=0.004)是3个月预后的独立危险因素;⑤淋巴细胞计数以及淋巴细胞与单核细胞比率与HT及预后无显著相关性;⑥嗜酸性粒细胞绝对值与HT及预后无显著相关性。结论①AIS患者接受rt-PA静脉溶栓治疗前的神经功能缺损情况是影响7d及3个月预后的主要因素;②心房颤动可增加AIS患者经rt-PA静脉溶栓治疗后HT的风险;③女性AIS患者经静脉rt-PA溶栓治疗后,3个月预后不良的危险性高;④较低的淋巴细胞计数以及较低的淋巴细胞与单核细胞比率没有显著增加HT及不良预后的风险;⑤较低的嗜酸性粒细胞绝对值没有显著增加HT及不良预后的风险。Objective To analyze the risk factors related to hemorrhagic transformation(HT)and prognosis of patients with acute ischemic stroke(AIS)after recombinant tissue plasminogen activator(rt-PA)therapy.Methods Patients who were diagnosed with AIS and received rt-PA therapy in the Department of Neurology of the Second Hospital of Hebei Medical University from January 2019 to November 2019 were included in this study.The general clinical data and HT of patients were analyzed.Patients’functional outcomes of 7 days and 3 months after onset were assessed.Results①A total of 91 patients were included in this study.There were 24 cases with HT,43 cases had a good prognosis on the 7 th day after rtPA treatment,and 53 cases had a good prognosis after 3 months;②The correlation between NIHSS score before thrombolysis and 7 th day prognosis was statistically significant(P<0.001);③The correlation between atrial fibrillation and HT was statistically significant(P=0.001);④Gender(P=0.009)and NIHSS score before thrombolysis(P=0.004)were independent risk factors for 3 months prognosis;⑤There was no significant correlation between lymphocyte count and the ratio of lymphocyte to monocyte with HT and prognosis;⑥There was no significant correlation between the eosinophils and HT,the eosinophils and prognosis.Conclusion①The neurological deficit before rt-PA thrombolysis in patients with AIS is the main factor affecting the 7 th day and 3 months prognosis;②Atrial fibrillation can increase the risk of HT in patients with AIS after rt-PA thrombolytic therapy;③Female patients with AIS are at high risk of poor 3 months prognosis after intravenous rt-PA thrombolytic therapy;④Lower lymphocyte count and low lymphocyte-to-monocyte ratio did not significantly increase the risk of HT and poor prognosis;⑤Lower eosinophils did not significantly increase the risk of HT and poor prognosis.

关 键 词：急性缺血性脑卒中 心房颤动 嗜酸性粒细胞 出血转化 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]