溶栓、抗凝、抗血小板治疗与脑微出血及脑梗死后出血性转换的关系

摘要

Objective To study the relationship about the therapies of thrombolysis, anticoagulation and anti-platelet procedure with CMB and post-thrombotic hemorrhage transformation. The purpose was to prevent the occurance of hemorrhagic transformation. Methods 678 patients of acute cerebral infarction had been admitted in the neurological department of this hospital from March 2005 to Dec. 2007, and 361 cases as normal controls had been taken for prospective studies. With x2 test, the incidence of different groups of complicating cerebral microbleeds,and the incidence of post-thrombolytic hemorrhage transformation had been compared. After logistic regression analysis, we identified the relationship of the thrombolysis, anticoagulation and anti-platelet procedure with CMB and that of post-thrombotic hemorrhage. All the patients had been scaned with MRI, SE, FSE, EPI, and GRE series.Results The prevalences of CMB had been found increased in the control group, cerebral infarction group, and post-thrombotic hemorrhage group. It had been 11％ , 22.6％ , and 40.7％ , respectively. ( x2= 29. 521, p= 0.000 ). After single-factor logistic regression analysis, it had been found that the therapies of anti-platelet, low molecular heparin calcium anticoagulation or urokinase thrombolysis had no relationship with CMB. With single-factor logistic regression analysis the post-infarction secondary hemorrhage had some relationship with auricular fibrillation, CMB and thrombolysis and had inverse correlation with serum fibrinogen concentration. With multiple regression analysis,it had beer found that the independent risk factors of secondary cerebral hemorrhage were the auricular fibrillation which made the incidence of secondary cerebral hemorrhage augmented by 6.51 times and the thrombolysis which made the incidience of it augmented by 4.90 times. The serum fibrinogen concentration was a protecting factor. When it was elevated by 1 gm/L, the secondary hemorrhagic cases could be decrease by half. Conclusion CMB is not the high risk factor of post-infarction hemorrhagic transformation. The therapies of thrombolysis, anticoagulation and anti-platelet procedure do not augment the incidence of CMB. The CMB do not augment the hemorrhagic risk of thrombolysis, anticoagulation and anti-platelet procedure. The thrombolysis and auricular fibrillation have some relationships with post-infarction hemorrhages.%目的 探讨溶栓、抗凝、抗血小板治疗与脑微出血及脑梗死后出血性转换的关系,以便预防出血性转换的发生.方法 对我院神经内科2005年3月-2007年12月住院的678例急性脑梗死患者和361例正常对照进行前瞻性研究.卡方检验对不同组别伴CMB的发病率,溶栓后合并出血性转换率进行比较,通过logistic回归分析确定溶栓、抗凝、抗血小板与CMB的相关性及与梗死后出血的相关性.全部研究对象进行MRI自旋回波序列( SE) 、快速自旋回波序列(FSE) 、场回波序列( FE)及梯度回波(GRE)扫描.结果 脑微出血患病率在对照组、梗死组、梗死后出血组依次升高,分别为11%、22.6%、40.7%,(χ2 ＝29.521,P=0.000),通过单因素logistic回归分析发现患者经抗血小板、低分子肝素钙抗凝,尿激酶溶栓治疗均与脑微出血的患病无关.梗死后脑出血单因素Logistic回归分析梗死后继发脑出血与房颤,脑微出血及溶栓治疗有关,与血浆纤维蛋白原浓度呈负相关.多因素logistic回归分析发现继发脑出血的独立危险因素为房颤、溶栓治疗,溶栓治疗的脑梗死患者继发出血的发生率增大6.51倍,伴有房颤的脑梗死患者继发脑出血的几率增大4.90倍.血浆纤维蛋白原浓度是保护性因素,每升高1g/L,继发出血者减少为原来的一半.结论 CMB不是脑梗死后出血转化的高危因素,溶栓、抗凝、抗血小板治疗不增加CMB的发病率,CMB并不增加溶栓、抗凝、抗血小板治疗的出血危险性,溶栓和房颤是梗死后出血的危险因素.