出血性转化类型对急性缺血性卒中患者溶栓治疗后神经功能的影响研究

摘要

目的 探讨出血性转化类型对急性缺血性卒中患者溶栓治疗后神经功能的影响.方法 选取2012年6月—2016年6月延安市博爱医院收治的急性缺血性卒中患者675例,其中发生出血性转化患者220例(剔除症状性出血患者30例),未发生出血性转化患者425例.所有患者予以重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗.比较不同类型出血性转化患者临床资料、实验室检查指标及神经功能损伤加重发生率,急性缺血性卒中患者溶栓治疗后早期神经功能损伤加重的影响因素分析采用多因素Logistic回归分析.结果 本组患者出血性转化发生率为32.6％(220/675),其中出血性梗死(HI)1型68例、HI2型58例、脑实质血肿(PH)1型42例、PH2型52例.不同类型出血性转化患者性别、年龄、心房颤动病史、高血压病史、糖尿病病史、高脂血症病史、吸烟史、冠心病发生率、发病至溶栓治疗时间、纤维蛋白原、血肌酐、血小板计数比较,差异无统计学意义(P＞0.05);不同类型出血性转化患者美国国立卫生研究院卒中量表(NIHSS)评分、收缩压、舒张压、空腹血糖及神经功能损伤加重发生率比较,差异有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,NIHSS评分[OR=3.317,95％CI (3.085,6.836)]、空腹血糖[OR=1.280,95％CI (1.054,1.554)]、出血性转化类型[OR=3.979,95％CI (1.774,8.922)]是急性缺血性卒中患者溶栓治疗后神经功能损伤加重的影响因素(P＜0.05).结论 出血性转化类型是急性缺血性卒中患者溶栓治疗后神经功能损伤加重的影响因素之一.%Objective To investigate the impact of types of hemorrhagic transformation on neurological function of acute ischemic stroke patients treated by thrombolytic therapy.Methods A total of 675 patients with acute ischemic stroke were selected in Boai Hospital of Yan'an from June 2012 to June 2016,thereinto 220 patients with hemorrhagic transformation were served as A group (rejected 30 patients with symptomatic hemorrhage),425 patients without hemorrhagic transformation were served as B group.All of the 675 patients received rt-PA for venous thrombolytic therapy.Clinical data,laboratory examination index and the aggravation rate of nerve function damage was compared in patients with different types of hemorrhagic transformation,and influencing factors of exacerbation of early neurological impairment in acute ischemic stroke patients treated by thrombolytic therapy were analyzed by multivariate Logistic regression analysis.Results The incidence of hemorrhagic transformation was 32.6％ (220/675),including 68 patients with type 1 hemorrhagic infarction,58 patients with type 2 hemorrhagic infarction,42 patients with type 1 brain parenchyma hematona and 52 patients with type 2 brain parenchyma hematoma.No statistically significant differences of gender,age,history of atrial fibrillation,hypertension,diabetes or hyperlipidaemia,smoking history,incidence of coronary heart disease,duration between attack and thrombolytic therapy,fibrinogen,Scr or PLT was found in patients with different types of hemorrhagic transformation (P ＞ 0.05),while there were statistically significant differences of NIHSS score,systolic blood pressure,diastolic blood pressure,FPG and the aggravation rate of nerve function damage in patients with different types of hemorrhagic transformation (P ＜ 0.05).Multivariate Logistic regression analysis results showed that,NIHSS score [OR =3.317,95％CI (3.085,6.836)],FPG [OR =1.280,95％CI (1.054,1.554)] and hemorrhagic transformation types [OR =3.979,95％ CI (1.774,8.922)] were influencing factors of exacerbation of early neurological impairment in acute ischemic stroke patients treated by thrombolytic therapy (P ＜ 0.05).Conclusion Hemorrhagic transformation types is one of the influencing factors of exacerbation of early neurological impairment in acute ischemic stroke patients treated by thrombolytic therapy.