脑梗死后出血性转化及其亚型危险因素分析

摘要

目的 探讨脑梗死后出血性转化(HT)及其亚型的危险因素差异,中国缺血性卒中病因分型(CISS)与HT的关系.方法 选择HT患者155例(HT组),HT亚型危险因素分为出血性脑梗死(HI)和脑实质血肿(PH)两型,欧洲急性卒中合作组织将HI分为HI-1和HI-2型,PH分为PH-1和PH-2型.抽取同期入院的非HT脑梗死患者250例(非HT组),收集人口学、病史、临床、实验室检查及影像资料,分析HT及其不同亚型的危险因素.结果 HT组中HI-1、HI-2、PH-1、PH-2比例分别为43.9％、33.5％、12.3％、10.3％.HT中CISS以大动脉粥样硬化和心源性栓塞比例较高.HT组大面积脑梗死、累及皮质、心源性栓塞、其他病因、入院时NIHSS评分较非HT组明显升高,穿支动脉疾病较非HT组明显降低(P＜0.05).多因素logistic回归分析显示,大面积脑梗死、累及皮质、年龄及入院时NIHSS评分是HT的独立危险因素,较高水平LDL-C及穿支动脉疾病HT的风险低.结论 大面积脑梗死、累及皮质、年龄、入院时NIHSS评分是HT的独立危险因素,HT亚型的独立危险因素存在差异.%Objective To study the relationship between Chinese Ischemic Stroke Subclassification (CISS) and hemorragic transformation (HT) after ischemic stroke.Methods One hundred and fifty-five HT patients served as a HT group and 250 HT-free ischemic stroke patients served as a HT-free group in this study.The risk factors for HT subtypes were divided into hemorrhagic infarction stroke (HI) and parenchymal hematoma (PH).HI was divided into HI-1 and HI-2,PH was divided into PH-1 and PH-2.Parameters of demography,medical history,clinical examination,laboratory testing,and imaging were collected from the two groups.The risk factors for HT and its subtypes were analyzed.Results The HI-1 and HI-2,PH-1 and PH-2 accounted for 43.9％ and 33.5％,12.3％ and 10.3％ respectively in HT group.The incidence of large artery atheroclerosis and cardioembolism was rather high in HT group according to the CISS.The incidence of massive isehemic stroke and involvement of cerebral cortex,cardioembolism and HT due to other etiologies according to the CISS and the NIHSS score orn admission were significantly higher while the incidence of penetrating artery disease according to the CISS was significantly lower in HT group than in HT-free group (P＜0.05).The massive ischemic stroke,involvement of cerebral cortex,age and NIHSS score on admission were the independent risk factors for HT while LDL-C and penetrating artery disease were the risk factors for HT.Conclusion Massive ischemic stroke,involvement of cerebral cortex,age and NIHSS score on admission are the independent risk factors for HT.The independent risk factors for HT subtypes are different.