急诊非瓣膜性心房颤动伴脑梗死后出血转化的研究  

A study on the hemorrhagic transformation after cerebral infarction in the patients with non-valvular atrial fibrillation in the emergency department

作　　者：乔允 陆晓晔[1] 于磊[1] 杨倩[1] 朱长清[1] 黄聪华 Qiao Yun;Lu Xiaoye;Yu Lei;Yang Qian;Zhu Changqing;Huang Conghua(Department of Emergency,the Renji Hospital Affiliated to School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院急诊科

出　　处：《脑与神经疾病杂志》2020年第3期163-168,共6页Journal of Brain and Nervous Diseases

基　　金：上海市科学技术委员会科研计划项目（15DZ1941307）

摘　　要：目的研究急诊科住院的非瓣膜性心房颤动(NVAF)合并脑梗死(CI)患者继发出血转化的临床特点。方法选取2014年1月至2018年5月于上海交通大学医学院附属仁济医院急诊病房及急诊ICU收治住院的155例诊断为NVAF的患者,分为非脑出血转化组(n=120)和脑出血转化组(n=35),比较一般临床资料、实验室指标及影像学特征。结果脑出血转化组空腹血糖和糖化血红蛋白水平均显著高于非脑出血转化组(P=0.042,P=0.027);脑出血转化组美国国立卫生院神经功能缺损评分(NHISS)相较于非脑出血转化组更高(P=0.015),而既往使用抗血小板药物(阿司匹林或氯吡格雷)预防CI的比例较后者更低(P=0.041),两组患者中CHA2DS2-VASc≥2分者接受抗凝治疗(华法林或新型口服抗凝药物)比例仅为7.38%(11/149);在影像学检查上,脑出血转化组的患者以出血性梗死表现为主(30/35,85.71%),大面积脑梗死、前循环梗死及皮质梗死的发生率均显著高于非脑出血转化组的患者(分别为P<0.01,P=0.022,P<0.01)。结论糖尿病是NVAF患者并发出血性脑梗死的危险因素;两组CI的NVAF患者的抗凝/抗血小板治疗率低,脑出血转化组的患者在发病前接受此项干预治疗率更低且病情更严重;大面积脑梗死、前循环梗死、皮质梗死为脑出血转化常合并的影像学特点,早期识别及严密监测能避免患者病情的持续恶化。Objectives To investigate the characteristics of hemorrhagic transformation(HT) after cerebral infarction(CI) in the patients with non-valvular atrial fibrillation(NVAF) in the emergency department.Methods A total of 155 patients who were admitted to the Emergency Ward and Emergency Intensive Care Unit(EICU) of Renji hospital,School of Medicine,Shanghai Jiaotong University due to NVAF with CI between January 2014 and May2018 were retrospectively included in this study.They were divided into two groups:non-hemorrhagic transformation group(non-HT group,n=120) and hemorrhagic transformation group(HT group,n=35).The medical records were analyzed,including clinical features,laboratory biomarkers,imaging findings.Results The fasting blood glucose and HbAlc in the non-HT group were significantly higher than those in the HT group(P=0.042 and P=0.027 respectively);Compared with non-HT group,HT group had significantly higher NHISS(National Institute of Health stroke scale) scores(P=0.015) and lower preventive usage of antiplatelet medicine(asprin or clopidogrel)(P=0.041).The rate of anticoagulant therapy(warfarin or novel oral anticoagulants)in the patients of both groups with CHA2 DS2-VASc≥2 is only 7.38%(11 in 149);In terms of imaging manifestations,hemorrhagic infarction(HI) was the main manifestation in HT group(30/35,85.71%).The incidence of large hemispheric infarction,anterior circulation infarction or cortex infarction in HT group was significantly higher than that in non-HT group(P<0.01,P=0.022,and P<0.01 respectively).Conclusions Diabetes mellitus was the risk factor of hemorrhagic transformation after CI in the patients with NVAF.Both of the two groups had accepted poor preventive treatment of antiplatelet/anticoagulant medicine,the patients in HT group had lower rate of such medication before onset of the disease and were more severe.Large hemispheric infarction,anterior circulation infarction and cortex infarction were the imaging features of cerebral hemorrhage transformation.Early identification and seriou

关 键 词：脑梗死 非瓣膜性房颤 脑出血转化 

分 类 号：R743.32[医药卫生—神经病学与精神病学]