摘要
目的探讨脑梗死发病前使用抗栓药物（抗凝或抗血小板聚集药物）对急性脑梗死后出血转化的影响。方法在成都卒中登记库基础上连续性纳入2004年1月1日至2014年1月1日期间于四川大学华西医院神经内科住院的急性脑梗死患者，并收集所有患者入院时的基线资料、既往抗凝药物及抗血小板聚集药物的使用情况，以及CT／ MRI等影像学资料。按照入院后72 h复查CT／ MRI等结果，将出血转化患者纳入到出血转化组，非出血转化患者按照1∶1比例入选与出血转化组性别、年龄匹配的患者为非出血转化组。对两组患者的基线资料、用药情况等进行比较。对两组间有差异的危险因素进行多因素Logistic回归分析，观察出血转化与病前使用抗栓药物的关系。结果共纳入急性脑梗死患者6916例，其中伴有出血转化433例（6.3％，出血转化组），未出血转化组患者433例。（1）两组患者入院时美国国立卫生研究院卒中量表（NIHSS）评分、心房颤动、既往脑梗死病史、入院时血糖水平差异均有统计学意义（均P ＜0.05）。（2）出血转化组使用抗凝药物及抗血小板聚集药物的比例均高于非出血转化组[抗凝药物：14.1％（61例）比3.9％（17例），P ＜0.01，OR ＝4.01，95％ CI：2.303～6.993；抗血小板聚集药物：14.3％（62例）比8.3％（36例），P ＝0.005，OR ＝1.84，95％ CI：1.194～2.846]。（3）多因素Logistic 回归分析结果显示，抗凝药物的使用、抗血小板聚集药物及入院NIHSS评分、入院随机血糖为出血转化的独立危险因素[OR（95％ CI）分别为3.302（1.860～5.862）、2.081（1.281～3.382）、1.047（1.026～1.069）、1.055（1.011～1.100），均P ＜0.05]。结论入院NIHSS评分、入院随机血糖为脑梗死出血转化的独立危险因素，发病前使用抗凝或抗血小板聚集药物与急性脑梗死后出血转化独立相关，其与急性�
Objective To investigate the impact of using antithrombotic drugs （anticoagulants or antiplatelet aggregation drugs）before the onset of cerebral infarction on hemorrhagic transformation after acute cerebral infarction. Methods The consecutive patients with acute cerebral infarction from Chengdu Stroke Registry Project admitted to the Department of Neurology,West China Hospital,Sichuan University from January 1,2004 to January 1,2014 were enrolled. The baseline data on admission,previous usage of anticoagulants and anti-platelet aggregation drugs,as well as CT/ MRI and other imaging data of all patients were collected. According to the results of CT/ MRI reexamined at 72 h after admission,the patients with hemorrhagic transformation were enrolled into a hemorrhagic transformation group;the patients with non-hemorrhagic transformation were enrolled into a non-hemorrhagic transformation group according to the ratio 〈br〉 of 1 ∶ 1. Their gender and age were matched with the hemorrhagic transformation group. The baseline data and drug used of the patients in both groups were compared. The differences of risk factors between the two groups were analyzed with multivariate Logistic regression analysis. The relationship between hemorrhagic transformation and premorbid use of antithrombotic drugs were observed. Results A total of 6 916 patients with acute cerebral infarction were enrolled,including 433 （6. 3%）hemorrhagic transformation （hemorrhagic transformation group）and 433 non-hemorrhagic transformation. （1）There were significant differences between the patients of the two groups on admission in the National Institutes of Health Stroke Scale （NIHSS）score,atrial fibrillation,previous cerebral infarction,and blood glucose levels on admission （all P ＆lt; 0. 05）. （2）The proportions of using anticoagulants and antiplatelet aggregation agents in the hemorrhagic transformation group were higher than those of the non-hemorrhagic transformation group （anticoagulants：14. 1% [n = 61]vs. 3. 9
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2015年第4期174-179,共6页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金资助项目(81371282)
关键词
脑梗死
抗凝药
血小板聚集抑制剂
出血转化
Brain infarction
Anticoagulants
Platelet aggregation inhibitors
Hemorrhagic transformation
