急性前循环脑梗死机械取栓术后出血转化发生率及影响因素  

Analysis of incidence and influencing factors of hemorrhagic transformation in patients with acute anterior circulation large vessel occlusive cerebral infarction after mechanical thrombolysis

作　　者：张莉[1] 文俊[1] 邵丽华[1] 李向东 夏俊[1] ZHANG Li;WEN Jun;SHAO Lihua;LI Xiangdong;XIA Jun(The First People’s Hospital of Changde,Changde 415000,China)

机构地区：[1]常德市第一人民医院,湖南常德415000

出　　处：《中国实用神经疾病杂志》2022年第7期851-857,共7页Chinese Journal of Practical Nervous Diseases

基　　金：常德市科技局一般指导项目(编号:2020S014)。

摘　　要：目的探讨急性前循环大血管闭塞性(LVO)脑梗死机械取栓(MT)术后出血转化(HT)发生率及影响因素。方法回顾性收集107例2020-01—2021-12序贯就诊于常德市第一人民医院神经内科确诊为急性前循环LVO脑梗死,并行急诊MT术患者临床资料,采用单因素和多因素Logistic回归分析MT术后HT发生影响因素,并行曲线拟合及阈值效益分析。结果107例急性前循环LVO脑梗死患者中32例术后发生HT,占29.91%,包括症状性HT 13例(12.15%)和非症状性HT 19例(17.76%)。多因素Logistic回归分析显示,术前侧支循环代偿程度低、术前急查外周中性粒细胞计数水平高、中性粒细胞/淋巴细胞比值(NLR)升高是急性前循环LVO脑梗死MT术后HT发生的独立危险因素(P<0.05)。应用平滑曲线拟合显示,术前急查NLR水平与急性前循环LVO脑梗死MT术后HT发生风险呈J型曲线关系,行阈值效应分析发现,曲线存在饱和效应值为6.3。结论术前侧支循环代偿程度低、术前急查外周中性粒细胞计数水平高、NLR升高是急性前循环LVO脑梗死MT术后HT发生的独立危险因素。监测术前NLR变化可成为预测急性前循环LVO脑梗死MT术后HT发生风险的有效措施。Objective To investigate the incidence and influencing factors of HT patients with acute anterior circulation LVO cerebral infarction after MT.Methods The clinical records of 107 patients with acute anterior circulation LVO cerebral infarction and underwent MT admitted to the first people’s hospital of Changde city from January 2020 to December 2021 were reviewed retrospectively.Univariate and multivariate logistic regression were used to analyze the risk factors,curve fitting and threshold benefit analysis were performed to further assess the association between the risk factors and HT.Results Among 107 patients with ACI,32 cases(29.91%)developed HT after MT,including 13 cases of symptomatic HT(12.15%)and 19 cases of non-symptomatic HT(17.76%).Multivariate logistic regression analysis illustrated that lower preoperative compensatory degree of collateral circulation,higher peripheral neutrophil count and higher preoperative NLR level were independent risk factors for HT after MT.Smooth curve fitting showed that the relationship between preoperative NLR level and HT occurrence after MT presented a J-shaped curve.Further threshold benefit analysis showed that when NLR<6.3,The risk of HT after MT was positively correlated with NLR level.Conclusion lower preoperative compensatory degree of collateral circulation,higher peripheral neutrophil count and higher preoperative NLR level were independent risk factors for HT after MT.Monitoring preoperative NLR changes can be an effective measure to predict the risk of HT after MT in acute anterior circulation LVO cerebral infarction.

关 键 词：急性前循环大血管闭塞性脑梗死 机械取栓 出血转化 影响因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]