中性粒细胞升高对急性缺血性脑卒中患者静脉溶栓后出血转化的影响  

Effect of elevated neutrophils on hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：杨志祥 杨思远 刘翠 胡书群 纵雪梅 燕宪亮 许铁 Yang Zhixiang;Yang Siyuan;Liu Cui;Hu Shuqun;Zong Xuemei;Yan Xianliang;Xu Tie(Department of Emergency and Rescue Medicine,Xuzhou Medical University,Xuzhou 221004,China;Emergency Center,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;Department of Emergency,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China;Department of Critical Care Medicine,Subei People's Hospital of Jiangsu Province,Yang⁃zhou 225600,China)

机构地区：[1]徐州医科大学急救与救援医学系,221004 [2]徐州医科大学附属医院急救中心,221002 [3]南京医科大学附属江宁医院急诊科,211100 [4]江苏省苏北人民医院重症医学科,扬州225600

出　　处：《国际麻醉学与复苏杂志》2020年第5期442-445,共4页International Journal of Anesthesiology and Resuscitation

基　　金：江苏省卫生与计划生育委员会基金指导课题(Z2017016);江苏省麻醉学重点实验室开放课题项目(KJS1704);徐州市科技项目(KCI7161)。

摘　　要：目的研究不同中性粒细胞水平对急性缺血性脑卒中(acute ischemic stroke,AIS)患者静脉溶栓后出血转化的影响。方法回顾性收集2017年1月-2019年3月在徐州医科大学附属医院因AIS接受静脉溶栓治疗患者的资料,共计177例。按溶栓前中性粒细胞计数水平,将177例患者分为低中性粒细胞组(<7.1×10^9/L)和高中性粒细胞组(≥7.1×10^9/L),分析两组患者基线资料和静脉溶栓后出血转化的差异。结果高中性粒细胞组患者静脉溶栓后出血发生率高于低中性粒细胞组(17.0%比5.6%,P=0.016);校正年龄、性别、抗栓及抗凝药服用史、既往脑卒中病史及美国国立卫生研究院卒中量表评分(National Institutes of Health Stroke Scale,NIHSS)后,多因素Logistic回归分析结果显示,高中性粒细胞计数水平是静脉溶栓后发生出血的独立危险因素[比值比(odds ratio,OR)=3.622,95%CI 1.099~12.203,P=0.035)]。结论中性粒细胞计数升高是AIS患者静脉溶栓后出血转化的独立危险因素。Objective To investigate the effects of elevated neutrophils on hemorrhagic transformation in patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods Clinical data were collected from 177 patients who underwent intra‐venous thrombolysis due to AIS in the Affiliated Hospital of Xuzhou Medical University between January 2017 and March 2019.Ac‐cording to the dichotomy of neutrophil levels(based on a median of 7.1×10^9/L),177 patients were divided into two groups:a low neutro‐phil level group(<7.1×10^9/L)and a high neutrophil level group(≥7.1×10^9/L).The baseline data and the changes of hemorrhagice trans‐formation risk after intravenous thrombolysis of the two groups were retrospectively analyzed.Results The incidence of hemorrhage after thrombolysis was higher in the high neutrophil level group than that in the low neutrophil level group(17.0%vs 5.6%,P=0.016).After adjusting for confounders including age,gender,anti‐thrombotic and anticoagulant medication history,previous stroke history and National Institutes of Health Stroke Scale(NIHSS)score,multivariable logistic regression analysis showed that the high level of neutro‐phil count was an independent risk factor for hemorrhage after intravenous thrombolysis[odds ratio(OR)=3.622,95%confidence inter‐val(CI)was 1.099‒12.203,P=0.035].Conclusions Increased neutrophil count is an independent risk factor for hemorrhagic trans‐formation after intravenous thrombolysis in patients with ischemic stroke.

关 键 词：急性缺血性脑卒中 溶栓 中性粒细胞 出血转化 

分 类 号：R74[医药卫生—神经病学与精神病学]