合并脑微出血小动脉闭塞型卒中患者rt-PA溶栓后出血转化及预后的影响因素分析  

Analysis of influencing factors of hemorrhagic transformation and prognosis after rt-PA thrombolysis in stroke patients with cerebral microbleeds and small artery occlusion

作　　者：唐伟 楚兰[1] 高子丹 倪睿涵 蔡刚 林翔 陈红群 TANG Wei;CHU Lan;GAO Zidan(Guizhou Medical University,Guiyang(55OOO4),Guizhou China)

机构地区：[1]贵州医科大学,贵州贵阳550004 [2]贵州医科大学附属医院神经内科,贵州贵阳550004

出　　处：《癫痫与神经电生理学杂志》2020年第6期348-355,共8页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的:探讨脑微出血(CMB)对小动脉闭塞型急性缺血性卒中患者rt-PA静脉溶栓后出血转化及预后的影响。方法:选择2018年1月至2020年2月在贵州医科大学附属医院神经内科进行rt-PA溶栓的小动脉闭塞型急性缺血性卒中患者作为研究对象,按有无CMB分为CMB阳性组与CMB阴性组,其中CMB阳性组根据CMB的个数分为低负荷组(1〜4个)和高负荷组CMB(≥5个)。所有患者均在时间窗内进行rt-PA静脉溶栓,并记录患者的一般临床资料。根据患者rt-PA静脉溶栓后7d的出血转化及90d的功能结局情况,判断CMB是否对小动脉闭塞型急性缺血性卒中rt-PA静脉溶栓产生影响。结果:共收集到CMB阳性组患者36例(40%),CMB阴性组患者53例(59%)。通过对患者溶栓后功能预后的单因素分析发现,CMB阳性组(χ^(2)=7.456,P=0.024),CMB高负荷组(χ^(2)=13.95,P=0.000)的患者有更高的功能结局不利和(或)不良。通过多因素有序Logistic回归分析发现,CMB阴性(OR=0.307,95%CI—2.340——0.021)以及既往无高血压病史(OR=0.193,95%CI,—3.054——0.234)较C M B阳性的及合并高血压病史的患者rt-PA静脉溶栓后功能预后不利和(或)不良的发生率更低。比较发现CMB阳性组与阴性组之间7d出血转化差异无显著意义。结论:①CMB的存在及CMB的负荷程度不增加小动脉闭塞型卒中患者rt-PA静脉溶栓后出血转化的风险;但可增加rt-PA静脉溶栓后功能结局不利和(或)不良的发生率;②虽然CMB的存在可导致小动脉闭塞型卒中患者静脉溶栓后更高的90 d功能结局不利和(或)不良率,但总体比例是比较低的,故对小动脉闭塞型卒中患者,在溶栓前行多模式的颅脑MRI检查可能是不必要的,因为这可能导致DNT时间的延长,从而降低静脉溶栓的效果。Objective:To investigate the effect of cerebral microbleeds(CMB)on hemorrhagic transformation and prognosis after rt-PA intravenous thrombolysis in patients with small arterial oc­clusive acute ischemic stroke.Methods:From January 2018 to February 2020,patients with small ar­terial occlusion acute ischemic stroke who underwent rt-PA thrombolysis in the Department of Neurol­ogy,Affiliated Hospital of Guizhou Medical University were selected as the research objects,and di­vided into CMB positive group and CMB negative group according to the presence or absence of CMB.CMB positive group was consisted of 2 subgroups:the low burden group CMB(1~4)and the high burden group CMB(≥5)according to the number of CMB.All patients underwent rt-PA intravenous thrombolysis within the time window and the general clinical data of the patients were recorded.Ac­cording to the hemorrhage conversion for 7 days after the patienfs rt-PA intravenous thrombolysis and 90 days,functional outcomes,the effect of CMB on rt-PA intravenous thrombolysis of acute ischemic stroke with small artery occlusion was judged.Results:A total of 36 patients(40%)in CMB positive group and 53 patients(59%)in CMB negative group were collected.A single factor analysis of func­tional prognosis after thrombolysis found that CMB positive group(χ^(2)=7.456,P=O.024)and the high burden group(χ2=13.95,P=O.000)had higher functional outcomes(adverse or unfavorable ones).The multi-factor ordered logistic regression analysis found that CMB negative group(OR,0.307;95%CI,—2.3400.021;P=O.046)and patients with no previous history of hypertension(OR,0.193;95%CI,—3.0540.234;P=0.022)showed more positive than CMB positive group.And patients with a history of hypertension had a lower incidence of adverse and(or)unfavor­able functional outcomes after rt-PA intravenous thrombolysis.The comparison among the groups found that there was no significant difference in hemorrhage conversion for 7 days between CMB posi­tive group and CMB negative group.Conclusions:①The prese

关 键 词：脑微出血(CMB) 小动脉闭塞型卒中 静脉溶栓 出血转化 功能结果 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]