脑白质高信号严重程度与急性缺血性卒中患者静脉溶栓后的出血转化及神经功能结局关系探讨  

The relationship between white-matter hyperintensities and hemorrhagic transformation and neurological outcome after intravenous thrombolysis in acute ischemic stroke

作　　者：洪浩敏[1] 陈松深[1] 邱浩强[1] 金钦华[2] 

机构地区：[1]南方医科大学附属普宁华侨医院神经内科,广东普宁515300 [2]汕头大学医学院第二附属医院神经内科

出　　处：《中国医师进修杂志》2014年第13期19-22,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨脑白质高信号（WMHs）严重程度与急性缺血性卒中患者静脉重组组织型纤溶酶原激活剂（rt-PA）溶栓后的出血转化以及3个月后神经功能结局之间的关系。方法回顾性分析接受静脉rt-PA溶栓治疗的急性缺血性卒中患者132例的临床资料，根据改良Schelten量表进行WMHs评分，出血转化包括出血性梗死（HI）型和脑实质出血（PH）型，改良Rankin评分2～6分定义为不利的神经功能结局。结果132例溶栓治疗共26例（19．7％，26／132）发生出血转化。其中17例为HI型，9例为PH型。经多元Logistic回归分析结果显示，基线美国国立卫生研究院卒中量表（NIHSS）评分、舒张压及WMHs评分与HI型出血转化无关（P〉0．05）；WMHs评分与PH型出血转化亦无相关性（P〈0．05），而基线NIHSS评分、舒张压是PH型出血转化的独立危险因素（P〈0．05）。二元Logistic回归分析结果显示，WMHs评分是不利的神经功能结局独立危险因素（OR=1．136，95％CI1．037-1．245，P=0．008）。结论严重WMHs不增加急性缺血性卒中静脉rt．PA溶栓后的出血转化风险，但与卒中后不利的神经功能结局有关。Objective To investigate the relationship between white-matter hyperintensities （WMHs） and hemorrhagic transformation and neurological outcome at 3 months after recombinant tissue plasminogen activator （rt-PA） treatment in patients with acute ischemic stroke. Methods The clinical data of 132 patients with acute ischemic stroke who had received intravenous rt-PA therapy were retrospectively reviewed.The severity of WMHs according to the modified Schehen scale was assessed. Hemorrhagic transformation included hemorrhagic infarct （HI） and cerebral parenchymal hemorrhage （PH）. Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale （mRS） at 3 months was also analyzed.Favorable neurological outcome as mRS 0 - 1 score and unfavorable neurological outcome as mRS 2 - 6 scores was defined. Results Hemorrhagic transformation was found in 26 patients （19.7%, 26/132） among 132 patients receiving intravenous rt-PA treatment. Seventeen patients were HI type and 9 patients were PH type. Multiple Logistic regression analysis showed that baseline American National Institute of Health Stroke Scale （NIHSS） score, diastolic pressure, WMHs score was not correlated with HI type hemorrhagic transformation （P 〉 0.05 ） ; and WMHs score was not correlated with PH type hemorrhagic transformation （P 〉0.05）,but baseline NIHSS score, diastolic pressure was the independent risk factor of PH type hemorrhagic transformation （P 〈 0.05 ）. Dicho-Logistic regression analysis showed that WMHs score was the independent risk factor of unfavorable neurological outcome （OR = 1.136,95% C1 1.037 - 1.245, P = 0.008）. Conclusion Severe WMHs are not associated with hemorrhagic transformation but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.

关 键 词：卒中 血栓溶解疗法 组织型纤溶酶原激活物 脑白质高信号 

分 类 号：R743.3[医药卫生—神经病学与精神病学]