非瓣膜性房颤脑梗死无症状性出血转化患者抗栓治疗疗效分析  

Study on anticoagulant treatment of asymptomatic hemorrhagic transformation after acute ischemic stroke with non-valve atrial fibrillation

作　　者：朱建建[1] 张爱萍[1] 施建生[2] 成亚琴[2] 张元媛[2] 樊兴娟[2] ZHU Jian-jian;ZHANG Ai-ping;SHI Jian-sheng;CHENG Ya-qin;ZHANG Yuan-yuan;FAN Xing-juan(Department of Neurology, the People’s Hospital of Rugao, Rugao 226500, Jiangsu, China;Department of Neurology, the Affiliated Hospital of Nantong University, Nantong 226000, Jiangsu, China)

机构地区：[1]如皋市人民医院神经内科,如皋226500 [2]南通大学附属医院神经内科,南通226000

出　　处：《中国临床医学》2020年第2期263-268,共6页Chinese Journal of Clinical Medicine

基　　金：南通市市级科技计划指导项目(MSZ18102).

摘　　要：目的:通过前瞻性观察性研究分析非瓣膜性房颤脑梗死无症状性出血转化患者的临床资料,探讨合并房颤的急性脑梗死出血转化患者行低剂量低分子肝素(low-molecular-weight heparin,LMWH)抗凝治疗的疗效。方法:纳入2016年1月至2018年11月在如皋市人民医院神经内科住院的非瓣膜性房颤脑梗死无症状性出血转化患者120例,根据是否予以低剂量低分子肝素抗凝治疗,分为抗凝组(n=56)和对照组(n=64),分析入组患者急性期的临床资料,随访30 d,以美国国立卫生研究院卒中量表(the National Institutes of Health Stroke Scale,NIHSS)减分值、30 d改良Rankin(mRs)评分、30 d良好预后(mRs 2分)、再发脑梗死、其他栓塞事件、颅内外出血事件为主要观察指标。结果:抗凝组和对照组在NIHSS减分值、再发脑梗死(1.79%vs 14.06%)差异有统计学意义(P<0.05);30 d mRs评分、30 d良好预后、颅内外出血事件及其他栓塞事件差异无统计学意义;单因素(抗凝治疗)分析显示,NIHSS减分值(OR=2.41,95%CI 1.30~3.51)、再发脑梗死(OR=0.10,95%CI 0.01~0.79)差异有统计学意义(P<0.05);多因素分析显示,NIHSS减分值(OR=39.87,95%CI 21.98~57.77)、再发脑梗死(OR=0.10,95%CI 0.01~0.86)差异有统计学意义(P<0.05)。结论:合并非瓣膜性房颤的急性脑梗死无症状性出血转化患者行低剂量低分子肝素抗凝治疗能改善神经功能,降低再发脑梗死风险,且不增加颅内外出血事件。Objective:To investigate the therapeutic effect of low-dose low-molecular-weight heparin(LMWH)anticoagulation therapy in acute phase by prospective observational study and analyze clinical data of patients with asymptomatic hemorrhage transformation after acute ischemic stroke with non-valve atrial fibrillation.Methods:The clinical data of 120 patients with asymptomatic hemorrhage transformation after acute ischemic stroke with non-valve atrial fibrillation hospitalized in Neurology of the People’s Hospital of Rugao from January 2016 to November 2018 were selected.According to whether the patients with hemorrhagic cerebral infarction were treated with LMWH,they were divided into two groups:anticoagulation group(n=56)and control group(n=64).All patients were followed up for 30 days,with National Institutes of Health Stroke Scale(NIHSS)reduction score,30 days modified Rankin(mRs)score,30 days good prognosis(mRs≤2),recurrentcerebral infarction,other embolic events,intracranial/extracranial hemorrhage events as the main observation indexs.Results:The main observation indexes of anticoagulant group and control group were compared:NIHSS reduction score,recurrentcerebral infarction(1.79%vs 14.06%)were statistically significantly different(P<0.05).There were no significant difference in 30 days mRs score,30 days good prognosis,intracranial/extracranial hemorrhage events and other embolization events.Single factor(anticoagulant therapy)analysis showed NIHSS reduction score(OR=2.41,95%CI 1.30-3.51),recurrentcerebral infarction(OR=0.10,95%CI 0.01-0.79)were statistically significant(P<0.05),and multi-factor analysis showed that NIHSS reduction score(OR=39.87,95%CI 21.98-57.77)and recerebral infarction(OR=0.10,95%CI 0.01-0.86)were statistically significant(P<0.05).Conclusions:LMWH anticoagulant therapy in the acute phase of asymptomatic hemorrhagic transformation after acute ischemic stroke with non-valve atrial fibrillation can improve neurological function,reduce the risk of recurrentcerebral infarction,and not increase

关 键 词：非瓣膜性房颤 脑梗死 出血转化 抗凝 低剂量低分子肝素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]