脑白质病变与急性缺血性卒中病人静脉溶栓后症状性颅内出血的关系  

Relationship between white matter lesion and symptomatic intracranial hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke

作　　者：王笑寒 潘燕[1] 张小林[1] 张向东[2] Wang Xiaohan;Pan Yan;Zhang Xiaolin;Zhang Xiangdong(Department of Neurology,Nanyang Central Hospital,Nanyang,Henan 473009,China;Department of Neurology,Anyang People's Hospital,Anyang,Henan 455002,China)

机构地区：[1]南阳市中心医院神经内科,河南南阳473009 [2]安阳市人民医院神经内科,河南安阳455002

出　　处：《中国微侵袭神经外科杂志》2024年第4期209-214,共6页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：河南省医学科技攻关计划项目(编号:LHGJ20200797)。

摘　　要：目的分析脑白质病变与急性缺血性卒中病人静脉溶栓后症状性颅内出血(symptomatic intracranial hemorrhage,sICH)的关系。方法回顾性分析400例符合溶栓治疗的急性缺血性卒中病例资料。根据磁共振成像,参考改良LA分级量表(age-related white matter changes,ARWMC)对脑白质病变进行量化评分。静脉应用重组人组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)治疗后24h内复查头颅CT,根据是否发生sICH转化分为sICH组(n=29)与非sICH组(n=371)。比较两组脑白质ARWMC评分及病变体积差异,采用Logistic回归,分析病人溶栓后发生sICH的影响因素;绘制受试者工作特征曲线(receiver operating characteristic,ROC),分析脑白质ARWMC评分及病变体积对病人溶栓后发生sICH的预测效能。结果400例病人静脉溶栓后sICH发生率为7.25%(29/400)。sICH组糖尿病史占比、NIHSS评分、大动脉粥样硬化占比、纤维蛋白原水平、ARWMC评分及脑白质病变体积均大于非sICH组(P<0.05)。绘制ROC曲线发现:ARWMC评分、脑白质病变体积及两者联合预测病人发生sICH的曲线下面积(areaundercurve,AUC)分别为0.825、0.861、0.938。结论脑白质病变评分及体积,与急性缺血性卒中病人静脉溶栓后sICH有关,可作为其预测因子。Objective To analyze the relationship between white matter lesions and symptomatic intracranial hemorrhage(sICH)after intravenous thrombolysis in patients with acute ischemic stroke.Methods The clinical data of 400 patients with acute ischemic stroke eligible for thrombolysis were analyzed retrospectively.Based on magnetic resonance imaging,the cerebral white matter lesions were quantitatively scored with the modified LA grading scale(age-related white matter changes,ARWMC).The patients were re-examined with head CT within 24 hours after intravenous application of recombinant tissue plasminogen activator(rt-PA)and were divided into sICH group(n=29)and non-sICH group(n=371)based on whether sICH occurred.The ARWMC scores and lesion volumes of white matter were compared between the two groups,and logistic regression was used to analyze the factors influencing sICH after thrombolysis.The receiver operating characteristic(ROC)curves were drawn to analyze the predictive efficacy of ARWMC scores and lesion volumes of white matter for the occurrence of sICH after thrombolysis.Results The incidence of sICH after intravenous thrombolysis was 7.25%(29/400)in the 400 patients.The proportion of diabetes history,NIHSS scores,the proportion of large artery atherosclerosis,fibrinogen levels,ARWMC scores,and cerebral white matter lesion volume were all higher in the sICH group compared to the non-sICH group(P<0.05).The ROC curve showed that the area under the curve(AUC)for predicting sICH in patients using ARWMC scores,white matter lesion volumes,and the combination of the two were 0.825,0.861,and 0.938 respectively.Conclusions The cerebral white matter lesion scores and volumes of white matter lesions are related to sICH after intravenous thrombolysis in patients with acute ischemic stroke and can be used as predictors.

关 键 词：缺血性卒中 急性 脑白质病变 静脉溶栓 症状性颅内出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]