急性脑梗死患者血管周围间隙扩大与静脉溶栓后出血转化的相关性  

Correlation between the enlarged perivascular spaces and hemorrhagic transformation after intravenous thrombolysis in patients with acute cerebral infarction

作　　者：权鹤太 王梦婷 张作慧 QUAN Hetai;WANG Mengting;ZHANG Zuohui(Xuzhou Medical University,Xuzhou 221000,China;The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,China)

机构地区：[1]徐州医科大学,江苏徐州221000 [2]徐州医科大学附属医院,江苏徐州221000

出　　处：《中国实用神经疾病杂志》2023年第10期1189-1194,共6页Chinese Journal of Practical Nervous Diseases

基　　金：江苏省自然科学基金资助项目(编号:BK20150219)。

摘　　要：目的探讨急性脑梗死(ACI)患者血管周围间隙扩大(EPVS)的严重程度与静脉溶栓后出血转化(HT)的关系。方法回顾性连续纳入2020-10—2022-10徐州医科大学附属医院行静脉溶栓治疗的587例ACI患者。根据EPVS部位分为基底节区和半卵圆中心,进一步根据视觉量化评分将基底节区EPVS与半卵圆中心EPVS分为轻度(0~1级)和中重度(2~4级)。根据溶栓后是否发生出血转化分为HT组和非HT组(NHT组),比较2组患者的基线资料及临床资料,并采用多因素Logistic回归分析EPVS与溶栓后HT的关系。结果静脉溶栓后587例患者中75例(12.78%)发生HT。2组患者在年龄、入院时收缩压、冠心病、心房颤动、基线NIHSS评分、尿酸、基线血糖、甘油三酯、脑白质高信号程度、基底节区EPVS严重程度方面比较存在统计学差异(P<0.05)。进一步经多因素Logistic分析得出,基线NIHSS评分(OR=1.073,P<0.001)、心房颤动(OR=2.136,P=0.023)、脑白质高信号程度(OR=1.902,P=0.041)、基底节区EPVS严重程度(OR=2.279,P=0.014)是溶栓后发生HT的独立危险因素。Spearman秩相关性分析显示,急性脑梗死患者静脉溶栓后HT与基底节区EPVS严重程度呈正相关(r=0.426,P=0.007)。结论基底节区EPVS严重程度是ACI患者静脉溶栓后发生HT的独立危险因素,HT的发生与中重度基底节区EPVS的严重程度呈正相关。Objective To investigate the relationship between the severity of enlarged perivascular spaces(EPVS)and hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute cerebral in⁃farction(ACI).Methods A total of 587 patients with ACI who received intravenous thrombolysis in the Affiliated Hospital of Xuzhou Medical University from October 2020 to October 2022 were retrospectively included.According to the site of EPVS,they were divided into basal ganglia area and hemi-oval center,and further divided into mild(grade 0-1)and moderate to severe(grade 2-4)EPVS in basal ganglia area and hemi-oval center according to visual quantitative scoring.The patients were divided into HT group and non-HT group according to whether bleeding transformation occurred after thrombolysis,and the baseline data and clinical data of the two groups were compared and the relationship between EPVS and HT after thrombolysis was investigated by multi-factor Logistic regression.Results After intravenous thrombolysis,HT occurred in 75(12.78%)of 587 patients.The differences between the two groups were statistically significant in terms of age,systolic blood pressure at admission,coronary artery disease,atrial fibrillation,baseline NIHSS score,uric acid,baseline glucose,triglycerides,cerebral white matter high signal,and the severity of EPVS in the basal ganglia region(P<0.05).Multifactorial Logistic re⁃gression analysis yielded that baseline NIHSS score(OR=1.073,P<0.001),atrial fibrillation(OR=2.136,P=0.023),cerebral white matter high signal(OR=1.902,P=0.041),and EPVS severity in the basal ganglia region(OR=2.279,P=0.014)were post-thrombolysis HT was an independent risk factor for HT after thrombolysis.Spearman rank correlation analysis showed that there was a positive correlation between the severity of EPVS in the basal ganglia and HT after intravenous thrombolysis in patients with acute cerebral infarction(r=0.426,P=0.007).Conclusion The severity of basal ganglia EPVS was an independent risk factor for HT after intrav

关 键 词：急性脑梗死 血管周围间隙扩大 静脉溶栓 出血转化 基底节区 半卵圆中心 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]