急性后循环缺血性卒中患者的出血性转化:危险因素和对转归的影响  

Hemorrhagic transformation in patients with acute posterior circulation ischemic stroke:risk factors and impact on outcomes

作　　者：张淑玲[1] 宋良 李浩然 付胜奇[1] 徐银燕 张洪涛[1] 任雅芳[1] 禹萌[1] Zhang Shuling;Song Liang;Li Haoran;Fu Shengqi;Xu Yinyan;Zhang Hongtao;Ren Yafang;Yu Meng(Department of Neurology,the People's Hospital of Zhengzhou,Zhengzhou 450003,China)

机构地区：[1]郑州人民医院神经内科,450003

出　　处：《国际脑血管病杂志》2020年第3期161-167,共7页International Journal of Cerebrovascular Diseases

基　　金：河南省医学科技攻关计划项目(2018020821);河南省医学科技攻关计划省部共建项目(SB201903029)。

摘　　要：目的探讨急性后循环缺血性卒中(posterior circulation ischemic stroke,PCIS)患者出血性转化(hemorrhagic transformation,HT)的危险因素和对转归的影响。方法回顾性纳入2016年7月至2019年10月在郑州人民医院神经内科住院并确诊为PCIS的患者。收集人口统计学、临床资料、实验室以及影像学检查结果。HT定义为发病后首次头颅CT/MRI未发现颅内出血,而发病后10 d内复查头颅CT/MRI检查时发现颅内出血。有症状HT定义为影像学复查提示颅内出血且美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增高。在发病3个月时应用改良Rankin量表进行转归评价,>2分定义为转归不良。应用多变量logistic回归分析确定HT、有症状HT以及转归不良的独立危险因素。结果共纳入242例PCIS患者,年龄(68.02±12.0)岁,女性111例(45.9%),基线中位NIHSS评分为5.9分(四分位数间距:3.1~8.8分)。19例(7.9%)发生HT,其中14例(73.7%)为有症状HT。3个月时随访显示,74例(30.58%)患者转归不良,其中12例死亡。多变量logistic回归分析显示,基线收缩压较高[优势比(odds ratio,OR)1.076,95%可信区间(confidence interval,CI)1.021~1.135,P=0.006;OR 1.161,95%CI 1.087~1.240,P<0.001]和梗死体积较大(OR 31.293,95%CI 4.542~215.592,P<0.001;OR 2.084,95%CI 1.414~3.073,P<0.001)是HT及有症状HT的独立危险因素。基线NIHSS评分较高(OR 1.511,95%CI 1.307~1.746;P<0.001)、糖尿病(OR 2.041,95%CI 1.054~3.952;P=0.034)和有症状HT(OR 4.514,95%CI 1.458~13.979;P=0.009)是转归不良的独立危险因素。结论HT在PCIS患者中较为少见。基线收缩压较高和梗死体积较大是PCIS患者发生HT的独立危险因素,基线NIHSS评分较高、糖尿病和有症状HT是PCIS患者转归不良的独立危险因素。Objective To investigate the risk factors for hemorrhagic transformation(HT)in patients with acute posterior circulation ischemic stroke(PCIS)and its impact on outcomes.Methods From July 2016 to October 2019,patients admitted to the Department of Neurology,the People's Hospital of Zhengzhou and diagnosed as PCIS were enrolled retrospectively.Their demography,clinical data,laboratory and imaging findings were collected.HT was defined as no intracranial hemorrhage detected by the first head CT/MRI after onset,and intracranial hemorrhage was found during head CT/MRI reexamination within 10 d after onset.Symptomatic HT was defined as intracranial hemorrhage indicated by imaging reexamination and the National Institutes of Health Stroke Scale(NIHSS)score was higher than the baseline.The outcome was evaluated by the modified Rankin Scale at 3 months after onset,and>2 were defined as poor outcome.Multivariate logistic regression analysis was used to identify the independent risk factors for HT,symptomatic HT,and poor outcomes.Results A total of 242 patients with PCIS were enrolled.Their age was 68.02±12.0 years,and 111 were females(45.9%).The baseline median NIHSS score was 5.9(interquartile range:3.1-8.8).HT occurred in 19 patients(7.9%),and 14 of them(73.7%)were symptomatic HT.Follow-up at 3 months showed that 74 patients(30.58%)had poor outcomes,of which 12 died.Multivariate logistic regression analysis showed that higher baseline systolic blood pressure(odds ratio[OR]1.076,95%confidence interval[CI]1.021-1.135,P=0.006;OR 1.161,95%CI 1.087-1.240,P<0.001)and larger infarct volume(OR 31.293,95%CI 4.542-215.592,P<0.001;OR 2.084,95%CI 1.414-3.073,P<0.001)were the independent risk factors for HT and symptomatic HT.The higher NIHSS score(OR 1.511,95%CI 1.307-1.746;P<0.001),diabetes mellitus(OR 2.041,95%CI 1.054-3.952;P=0.034)and symptomatic HT(OR 4.514,95%CI 1.458-13.979;P=0.009)were the independent risk factors for poor outcomes.Conclusions HT is rare in patients with PCIS.Higher baseline systolic blood pressure and larg

关 键 词：卒中 脑缺血 脑出血 磁共振成像 治疗结果 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]