阿替普酶静脉溶栓治疗急性缺血性脑卒中后出血性转化的影响因素分析  

Analysis of influencing factors of hemorrhagic transformation after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke

作　　者：刘春梅[1] 周俊山[1] 施洪超[1] 黄清[1] LIU Chunmei;ZHOU Junshan;SHI Hongchao;HUANG Qing(Department of Neurology,Nanjing First Hospital,Nanjing Medical University,Nanjing Jiangsu 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)神经科,210006

出　　处：《中国神经免疫学和神经病学杂志》2018年第3期188-192,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨急性缺血性脑卒中(AIS)经阿替普酶静脉溶栓治疗后出血性转化(HT)的影响因素。方法选取2015-01—2017-07作者医院收治的经阿替普酶静脉溶栓治疗的AIS患者348例,根据阿替普酶静脉溶栓后是否发生HT将患者分为出血组和未出血组。回顾性收集所有研究对象的临床资料(人口统计学、血管危险因素和实验室检查指标等),采用多因素Logistic回归分析探讨ALS经阿替普酶静脉溶栓治疗后发生HT的独立危险因素。结果出血组32例,未出血组316例。两组患者间基线血糖、基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、发病至静脉溶栓治疗时间、心房颤动史、溶栓24h后收缩压以及抗血小板药物服用史差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,基线血糖(OR=3.781,95%CI:1.851~11.765)、基线NIHSS评分(OR=2.678,95%CI:1.384~10.441)、发病至静脉溶栓治疗时间(OR=2.436,95%CI:1.324~4.488)、心房颤动史(OR=4.538,95%CI:2.036~14.132)和溶栓24h后收缩压(OR=1.581,95%CI:1.071~6.415)是发生HT的独立危险因素(均P<0.05)。结论基线血糖、基线NIHSS评分、发病至静脉溶栓治疗时间、心房颤动史和溶栓24h后收缩压是脑梗死患者静脉溶栓后发生HT的危险因素。Objective To investigate the influencing factors of hemorrhagic transformation after intravenous thrombolytic therapy with alteplase in patients with acute ischemic stroke.Methods From January 2015 to July 2017,348 patients with acute ischemic stroke and treated with intravenous thrombolysis using alteplase were selected as the research subjects,according to the presence of hemorrhagic transformation after intravenous thrombolysis,the patients were divided into a bleeding group（32 cases）and a non-bleeding group（316 cases）.The clinical data（demographic,vascular risk factors,laboratory examinations and so on）of all the subjects were retrospectively collected,multivariate logistic regression analysis was used to explore the independent risk factors of hemorrhagic transformation.Results There were significant differences in baseline blood glucose,baseline NIHSS score,time to initiation of intravenous thrombolysis,history of atrial fibrillation,and history of antiplatelet medication between the bleeding group and the non-bleeding group（P〈0.05）.Multivariate logistic regression analysis showed that baseline blood glucose（OR =3.781,95%CI1.851-11.765）,baseline NIHSS score（OR=2.678,95%CI 1.384-10.441）,time from onset to intravenous thrombolysis（OR=2.436,95%CI 1.324-4.488）,history of atrial fibrillation（OR=4.538,95%CI 2.036-14.132）and 24 h systolicblood pressure after thrombolysis（OR = 1.581,95% CI 1.071-6.415） were independent risk factors for hemorrhagic transformation（P〈0.05）.Conclusions Baseline blood glucose,baseline NIHSS score,time from onset to intravenous thrombolysis,history of atrial fibrillation and 24 h systolicblood pressure after thrombolysis are risk factors associated with hemorrhagic transformation after thrombolytic therapy in acute cerebral infarct patients.

关 键 词：脑缺血 卒中 组织型纤溶酶原激活物 静脉溶栓 出血性转化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]