急性缺血性卒中患者静脉溶栓后出血性转化的神经影像学特征  

Neuroimaging features of hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：陈念 王春茹 聂小娟 Chen Nian;Wang Chunru;Nie Xiaojuan(Department of Neurology,Ninghe District Hospitol,Tiaijin 301500,China)

机构地区：[1]天津市宁河区医院神经内科,301500

出　　处：《国际脑血管病杂志》2022年第9期671-677,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性缺血性卒中静脉溶栓后出血性转化(hemorrhagic transformation,HT)的神经影像学特征。方法回顾性纳入2018年4月至2022年5月在天津市宁河区医院神经内科接受标准剂量阿替普酶静脉溶栓且在治疗后24 h内发生HT的急性缺血性卒中患者。记录患者的人口统计学、临床资料以及HT的神经影像学表现。比较有症状颅内出血(symptomatic intracranial hemorrhage,sICH)组与无症状颅内出血(asymptomatic intracranial hemorrhage,asICH)组以及梗死灶内HT组和梗死灶外HT组的临床资料。应用多变量logistic回归分析确定HT类型的独立危险因素。结果共纳入63例HT患者,男性40例,女性23例,年龄(73.5±8.95)岁;sICH 42例(66.7%),asICH 21例(33.3%)。梗死灶内HT 37例(58.7%)[ECASS分型:出血性梗死(hemorrhagic infarction,HI)-1型5例(7.9%),HI-2型6例(9.5%),脑实质血肿(parenchymal hematoma,PH)-1型11例(17.5%),PH-2型15例(23.8%)],梗死灶外HT 17例(27.0%),梗死灶内和梗死灶外同时HT 9例(14.3%)。海德堡分型:1a HI-1型5例(7.9%),1b HI-2型6例(9.5%),1c PH-1型11例(17.5%),2型15例(23.8%),3a型14例(22.2%),3b型6例(9.5%),3c型4例(6.3%),3d型2例(3.2%)。多变量logistic回归分析显示,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较低[优势比(odds ratio,OR)1.413,95%置信区间(confidence interval,CI)1.216~1.447;P=0.001]、小血管闭塞(OR 1.378,95%CI 1.134~1.429;P=0.002)、轻度卒中(OR 1.447,95%CI 1.120~1.467;P<0.001)以及梗死灶外HT(OR 1.335,95%CI 1.131~1.363;P=0.007)与sICH存在独立相关性;基线NIHSS评分较高(OR 1.737,95%CI 1.102~1.801;P<0.001)、心源性栓塞(OR 1.789,95%CI 1.095~1.881;P<0.001)以及重度卒中(OR 1.648,95%CI1.110~1.672;P<0.001)与梗死灶内HT存在独立相关性。结论急性缺血性卒中患者静脉溶栓后HT最常见的神经影像学特征为梗死灶内PH,而远离梗死灶HT以及梗死灶内和梗死灶外同时HT很少见。基线NIHSS评分较高Objective To investigate the neuroimaging features of hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke received intravenous thrombolysis with a standard dose of alteplase in the Department of Neurology,Ninghe District Hospital from April 2018 to May 2022 and had HT within 24 h after treatment were retrospectively included.Demography,clinical data and neuroimaging findings of HT were recorded.The clinical data of symptomatic intracerebral hemorrhage(sICH)group and asymptomatic intracerebral hemorrhage(asICH)group,as well as HT in the infarct group and HT outside the infarct group were compared.Multivariate logistic regression analysis was used to determine independent risk factors for HT types.Results A total of 63 patients with HT were enrolled(40 males and 23 females,aged 73.5±8.95 years).There were 42 patients with sICH(66.7%),21(33.3%)with asICH,37(58.7%)with HT in the infarct(ECASS classification:hemorrhagic infarction[HI]-1,5 cases[7.9%];HI-2,6 cases[9.5%];parenchymal hematoma[PH]-1,11 cases[17.5%];PH-2,15 cases[23.8%]),17(27.0%)with HT outside the infarct,and 9 cases(14.3%)with HT both inside and outside the infarct.Heidelberg classification:1a HI-1,5 cases(7.9%);1b HI-2,6 cases(9.5%);1c PH-1,11 cases(17.5%);2,15 cases(23.8%);3a,14 cases(22.2%);3b,6 cases(9.5%);3c,4 cases(6.3%);and 3d,2 cases(3.2%).Multivariate logistic regression analysis showed that lower baseline National Institutes of Health Stroke Scale(NIHSS)score(odds ratio[OR]1.413,95%confidence interval[CI]1.216-1.447;P=0.001),small vessel occlusion(OR 1.378,95%CI 1.134-1.429;P=0.002),minor stroke(OR 1.447,95%CI 1.120-1.467;P<0.001),and HT outside the infarct(OR 1.335,95%CI 1.131-1.363;P=0.007)were independently associated with sICH.Higher baseline NIHSS scores(OR 1.737,95%CI1.102-1.801;P<0.001),cardiogenic embolism(OR 1.789,95%CI 1.095-1.881;P<0.001),and severe stroke(OR 1.648,95%CI 1.110-1.672;P<0.001)were independently associated with HT in the infarc

关 键 词：卒中 脑缺血 血栓溶解疗法 颅内出血 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]