脑白质疏松程度与急性脑梗死患者静脉溶栓治疗后症状性脑出血转化的相关性研究  

Study on the correlation between the severity of leukoaraiosis and symptomatic intracerebral hemorrhage after intravenous thrombolytic therapy in patients with acute cerebral infarction

作　　者：孙威[1] 马舒贝[2] 陈忠军[2] 张静波[1] 杨颖[1] 李雪媛[1] 王洪志[1] 滕秀涵[1] 常红[1] 

机构地区：[1]大连市第三人民医院神经内科,116033 [2]大连市中心医院神经内科

出　　处：《临床神经病学杂志》2016年第5期329-332,共4页Journal of Clinical Neurology

基　　金：大连市局卫生计生机构医学科研课题(2013-34)

摘　　要：目的探讨脑白质疏松（LA）程度与急性脑梗死患者静脉应用重组人组织型纤溶酶原激活剂（rt-PA）溶栓治疗后症状性脑出血（sICH）转化的相关性。方法连续选取急性颈内动脉系统脑梗死患者117例,符合溶栓治疗指征者采用静脉rt-PA以0.9 mg/kg足量溶栓治疗,其余则给予普通安慰剂治疗。所有患者根据Wahlund改良LA分级量表（ARWMC）评分对LA严重程度进行分级：轻度（1~5分）,中度（6~10分）,重度（〉10分）。溶栓后24~36 h复查头CT,判定是否出现sICH转化。比较不同程度LA患者中溶栓组和安慰剂组sICH转化率。结果本研究组中,溶栓治疗者49例,安慰剂使用者68例;LA轻度45例,LA中度25例,LA重度47例。本研究共有10例患者（8.5%）发生s ICH转化,其中溶栓治疗者7例,安慰剂使用者3例;LA轻度2例,LA中度2例,LA重度6例。在LA轻度及中度患者中,溶栓组患者sICH转化率略高于较安慰剂组（P=0.052,P=0.650）。而在LA重度患者中,溶栓组患者s ICH转化率明显高于安慰剂组（P=0.043）。Pearson相关性分析结果显示,溶栓组患者ARWMC评分与其静脉溶栓治疗后sICH转化率呈正相关（r=0.476,P=0.0005）。结论重度LA可增加急性脑梗死患者rt-PA静脉溶栓后sICH转化的风险。了解患者的LA程度有助于对临床溶栓决策的选择和对患者预后的判断。Objective To study the correlation between the severity of leukoaraiosis（ LA） and the incidence of symptomatic intracerebral hemorrhage（ s ICH） after intravenous thrombolytic therapy with recombinant-tissue plasminogen activator（ rt-PA） in patients with acute cerebral infarction. Methods One hundred and seventeen patients with acute cerebral thrombosis in internal carotid artery system were collected. Patients comformed to the indications were intravenous adminstrated with rt-PA（ 0. 9 mg / kg）,while the other patients were treated with placebo. The severityratings of LA were evaluated by Age-related white matter changes scale（ ARWMC） scale： mild1- 5 points,moderate 6- 10 points,severe 〉10 points. In order to detect hemorrhagic transformation,all the patients in thrombolysis group had the second head CT scan between 24- 36 h after thrombolysis. The s ICH incidence between thrombolysis group and placebo group in different severityratings of LA were compared. Results In all 117 cases,there were thrombolysis treated patients 49 cases and placebo treated patients 68 cases,LA mild degree patients 45 case,moderate degree patients 25 cases and severe degree patients 47 cases. s ICH was detected in10 cases（ 8. 5%）,7 cases were thrombolysis treated patients and 3 cases were placebo treated patients. In all the 10 s ICH cases,2 s ICH cases belong to LA mild degree,2 s ICH belong to moderate and 6 cases belong to severe degree.In mild and moderate degree LA cases,s ICH incidences were significantly higher in thrombolysis group than placebo group（ P = 0. 052,P = 0. 650）. In severe degree LA cases,s ICH incidence was significantly higher in thrombolysis group than placebo group（ P = 0. 043）. Pearson correlation analysis showed ARWMC score were positively correlated with the incidence of s ICH in thrombolysis group（ r = 0. 476,P = 0. 0005）. Conclusions Severe degree of LA may increase the risk of incidence of s ICH in intravenous thrombolytic therapy for acute ischemic stroke. Evaluation

关 键 词：脑白质疏松 急性脑梗死 静脉溶栓治疗 症状性脑出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]