急性缺血性脑卒中机械取栓术后出血转化及其对预后的影响  

Hemorrhagic transformation after mechanical thrombectomy for acute ischemic stroke and its effect on prognosis

作　　者：张艳[1,2] 周霞[1] 王幼萌[2] 涂峰 陈巨罗 姚明仁 孙中武[1] Zhang Yan;Zhou Xia;Wang Youmeng;Tu Feng;Chen Juluo;Yao Mingren;Sun Zhongwu(Dept of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022;Dept of Neurology, The Affiliated Fuyang People′s Hospital of Anhui Medical University, Fuyang 236000)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230022 [2]安徽医科大学附属阜阳市人民医院神经内科,阜阳236000

出　　处：《安徽医科大学学报》2022年第6期987-990,共4页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81771154);安徽省重点研究与开发计划项目(编号:202104j07020031)。

摘　　要：目的 探讨急性缺血性脑卒中(AIS)患者机械取栓(MT)治疗后出血转化(HT)及其对预后的影响。方法 选取接受MT治疗的AIS患者114例,应用改良Rankin量表随访评价发病90 d时的临床转归(0~2分为预后良好,3~6分为预后不良)。根据术后复查头颅CT有无HT分为HT组(n=25)和非HT组(n=89),采用二项式Logistic回归分析确定术后HT和预后的影响因素。结果 114例患者中HT 25例,非HT 89例。HT组患者合并糖尿病比例显著高于非HT组,出院时NIHSS评分高于非HT组,90 d预后较好比例显著低于非HT组,差异均有统计学意义(均P<0.05);二项式Logistic回归分析显示,糖尿病、高总胆固醇血症、吸烟史是取栓术后发生HT的主要血管危险因素(均P<0.05)。术后HT是动脉取栓术后不良预后的重要影响因素(P=0.026)。结论 糖尿病、高总胆固醇血症、吸烟史是AIS患者MT术后HT的血管主要危险因素,而术后HT为MT术后预后不良的独立危险因素。Objective To explore the hemorrhagic transformation(HT)and its effect on prognosis in patients with acute ischemic stroke(AIS)after mechanical thrombectomy(MT).Methods A total of 114 patients with AIS received MT were enrolled.The modified Rankin Scale was used to evaluate the clinical outcome at 90 days of onset(0-2 points were good prognosis;3-6 points were poor prognosis).The patients were divided into HT group(n=25)and non-HT group(n=89)according to their HT conditions.Binomial Logistic regression analysis was performed to determine the vascular risk factors of HT after MT and the effect of HT on prognosis.Results Among 114 patients,there were 25 cases of HT and 89 cases of non HT.The proportion of patients with diabetes in HT group was significantly higher than that in non-HT group.The NIHSS score of HT group at discharge was significantly higher than that in non-HT group.The proportion with good prognosis at 90 days in HT group was significantly lower than that in non-HT group(all P<0.05).Binomial Logistic regression analysis showed that diabetes,high levels of cholesterol and smoking were the major vascular risk factors for HT after thrombectomy(all P<0.05).HT was an important factor affecting the poor prognosis after arterial thrombectomy(P=0.026).Conclusion Diabetes,high levels of cholesterol and smoking are the main risk factors of HT after MT for AIS.HT is an independent risk factor for poor prognosis after MT.

关 键 词：缺血性脑卒中 机械取栓 出血转化 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]