急性缺血性卒中的出血性转化和转归：回顾性病例系列研究  

Henmrrhagic transformation and outcomes in acute ischemic stroke： a retrospective case series study

作　　者：万琛宜[1] 黄经纬[1] 洪道俊[1] 万慧[1] 吴裕臣[1] 徐文苑[1] 

机构地区：[1]南昌大学第一附属医院神经内科,南昌330006

出　　处：《国际脑血管病杂志》2013年第3期161-165,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性缺血性卒中的出血性转化（hemorrhagic transformation，HT）和转归。方法回顾性收集急性缺血性卒中患者的人口统计学、血管危险因素、影像学和其他临床资料并进行比较；利用磁敏感加权成像（susceptibility weighted imaging,SWI）诊断HT，并将患者分为HT组和非HT组；应用改良Rankin量表评价临床转归。采用多变量logistic回归分析确定HT以及HT患者转归不良的独立危险因素。结果共纳入96例急性缺血性卒中患者，其中34例出现HT（35．4％）。HT组年龄[（66．21±7．04）岁对（61．21±13．42）岁；t=2．020，P=0．046]和梗死体积[（3．88±2．20）cm^3对（1．96±1．37）耐；t=5．267，P=0．001]显著性大于非HT组，高血压（58．8％对30．6％掰。=7．228，P=0．007）、糖尿病（29．4％对6．5％；X^2=9．293，P=0．002）、心房颤动（35．3％对3．2％；X^2=18．128，P=0．000）、心源性脑栓塞（35．3％对3．2％；P=0．000）患者的构成比显著性高于非HT组，而小动脉闭塞性卒中患者的构成比显著性低于非HT组（38．2％对62．9％；P=0．032）。多变量logistic回归分析显示，年龄[优势比（oddsratio，OR）1．168，95％可信区间（confidenceinterval，C／）1．059～3．412；P=0．021]、梗死体积（OR3．461，95％C／1．317～6．270；P=0．044）和心房颤动（OR1．284，95％C／1．117～2．903；P=0．015）为HT的独立危险因素。在HT患者中，转归不良组年龄[（69．46±7．17）岁对（64．19±6．31）岁；t=2．248，P=0．032]显著性大于转归良好组，高血压（84．6％对42．9％；X^2=5．781，P=0．016）、糖尿病（50．0％对14．3％；X^2=6．053，P=0．014）、心源性脑栓塞（61．5％对19．O％；JP=0．025）和血肿型HT（76．9％对19．0％拼。=11．104，P=0．001）的构成比显著性高于转归良好组。多变量logistic回归分析显示，糖尿病（OR2．151，95％C／1�Objective To investigate hemorrhagic transformation （HT） and outcomes in acute ischemic stroke. Methods The demographics, vascular risk factors, imaging and other clinical data in patients with acute isehemic acute were collected retrospectively and compared. Using the susceptibility weighted imaging （SWI） to diagnose HT, and the patients were divided into either a HT group or a non-HT group. The modified Rankin scale was used to evaluate the clinical outcomes. Multivariate logistic regression analysis was used to determine the independent risk factors for HT and poor outcome in HT patients. Results A total of 96 patients with acute ischemic stroke were enrolled and 34 of them had HT （35.4%）. The age （66. 21 ± 7. 04 years vs. 61.21 ±13.42 years; t =2. 020, P=0. 046） and infarct volume （3.88 ±2. 20 cnn3 vs. 1.96± 1.37 cm^3; t =5.67, P= 0. 001） in the HT group were significantly older or larger than those in the non-HT group. The proportions of hypertension （58. 8% vs. 30. 6% ; Xz = 7. 228, P = 0. 007）, diabetes （29. 4% vs. 6. 5% ; X^2 = 9. 293, P = 0. 002）, atrial fibrillation （35.3% vs. 3.2% ; X^2 = 18. 128, P = 0. 000）, and cardiogenic cerebral embofism （35.3% vs. 3.2% ; P =0. 000） were significantly higher than those in the non-HT group, while the proportion of small arterial occlusive stroke was significantly lower than that in the non-HT group （38.2% vs. 62. 9% ; P =0. 032）. Multivariate logistic regression analysis showed that age （odds ratio [ OR] 1. 168, 95% confidence interval [ CI] 1. 059 -3.412; P =0. 021）, infarct volume （OR 3.461, 95% CI 1. 317 -6. 270; P =0. 044） and atrial fibrillation （OR 1. 284, 95% CI 1. 117 -2. 903; P =0.015） were the independent risk factors for HT. In the HT patients, age （69. 46 ±7. 17 years vs. 64. 19 ±6. 31 years; t =2. 248, P =0. 032） in the poor outcome group was significantly older than that in the the outcome group. The proportions of hypertension （84. 6% vs. 42. 9% ;X^2 =781, P =0. 016）, diabetes （50.

关 键 词：卒中 脑缺血 脑出血 磁共振成像 危险因素 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]