急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓后出血性转化的危险因素分析

摘要

目的 探讨急性脑梗死患者静脉输注重组组织型纤溶酶原激活剂(rt-PA)后出血性转化的相关危险因素.方法 采用病例-对照研究的方法,选取21例急性脑梗死接受rt-PA静脉溶栓治疗后出现脑出血性转化者为病例组,并选择同一时期63例急性脑梗死接受rt-PA静脉溶栓治疗后来发生脑出血性转化者为对照组.应用单因素及多因素logistic回归分析溶栓后出血性转化的相关危险因素.结果 单因素分析结果显示,病例组中溶栓前美国国立卫生院卒中量表(NIHSS)评分＞10分、高血压(溶栓前收缩压≥140 mmHg)、溶栓前血糖值升高、具有心房颤动史和脑血管疾病史的比例显著高于对照组.多因素logistic回归分析结果显示,溶栓前收缩压≥140 mmHg (OR=14.59,95％CI:1.63～130.95)、溶栓前血糖值升高(OR=9.92,95％CI:0.97～101.24)以及具有脑血管疾病史(OR=10.75,95％CI:1.76～65.78)是急性脑梗死患者接受rt-PA静脉溶栓后出血性转化的危险因素.结论 溶栓前收缩压≥140 mmHg、溶栓前血糖值升高以及具有脑血管疾病史是急性脑梗死患者接受rt-PA静脉溶栓后出血性转化的危险因素.%Objective To investigate the risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) in patients diagnosed with acute ischemic stroke.Methods The design for this research was a case-control study-21 patients with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA were categorized as cases,and 63 patients without hemorrhagic transformation after administration of thrombolytic therapy using rt-PA were categorized as controls.Univariate and multivariate logistic regression analysis were performed to analyze the risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA in patients diagnosed with acute ischemic stroke.Results Results of univariate analysis showed that positive baseline National Institutes of Health Stroke Scale (NIHSS) scores ＞ 10,hypertension,baseline systolic blood pressure (SBP) ≥ 140 mmHg,increased blood glucose level,history of atrial fibrillation,and cerebrovascular disease (CVD) were significantly higher in the case group than in the control group.Results of multivariate logistic regression analysis showed that baseline SBP ≥ 140 mmHg (OR =14.59,95％ CI:1.63-130.95),increased blood glucose level (OR =9.92,95％ CI:0.97-101.24),and history of CVD (OR =10.75,95％ CI:1.76-65.78) were independent risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA in patients diagnosed with acute ischemic stroke.Conclusion Baseline SBP ≥ 140 mmHg,increased blood glucose level,and history of CVD were observed to be independent risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA in patients diagnosed with acute ischemic stroke.