摘要
目的探讨脑梗死后出血性转化的危险因素。方法选择湛江中心人民医院2008年1月至2015年12月住院的急性出血性脑梗死患者233例作为研究对象。其中,自发性出血性转化145例,动静脉溶栓[应用尿激酶（100～150）万U静脉注射]后出血性转化52例,抗凝和抗血小板治疗后出血性转化36例。对影响因素如神经功能缺损评分、脑梗死体积、糖尿病病程、高血压病程、糖化血红蛋浓度、皮质下脑白质病变、低密度脂蛋白（LDL）、颈动脉狭窄程度、颈动脉内膜-中层厚度、颈动脉斑块大小、高尿酸血症分别采用线性回归和逐步回归进行分析,探索其对出血性转化的影响。结果自发性脑梗死后出血性转化、脑梗死溶栓后出血性转化及抗血小板治疗后的出血性转化,均与神经功能缺损评分、脑梗死体积、糖尿病病程、高血压病程、糖化血红蛋白浓度、皮质下脑白质病变、LDL、颈动脉狭窄程度、颈动脉内膜-中层厚度、颈动脉斑块大小、高尿酸血症呈正相关（均P〈0.05）。回归分析显示,影响脑梗死后出血性转化的主要危险因素是神经功能缺损评分、脑梗死体积、糖尿病和高血压病程及伴心房颤动、糖化血红蛋白、LDL和血尿酸、皮质下脑白质病变、颈动脉狭窄、颈动脉内膜-中层厚度、斑块大小等（均P〈0.05）。结论急性脑梗死后实施溶栓、抗栓、抗血小板等干预措施时应密切关注相关高危因素。
Objective To analyze the risk factors of hemorrhagic transformation after ischemic stroke. Methods Two hundred and thirty-three cases of patients with acute hemorrhagic cerebral infarction in Central People Hospital of Zhanjiang from January 2008 to December 2015 were selected as the research objects,which involved in 145 patients with spontaneous hemorrhagic transformation,52 patients with hemorrhagic transformation after arterio-venous thrombolysis,36 patients with hemorrhagic transformation after anticoagulation and antiplatelet. The related risk factors [neural function defect scale,cerebral infarction volume,duration of diabetes,duration of high blood pressure,blood of glycosylated hemoglobin,the degree of subcortical leukoencephalopathy,low density lipoprotein（ LDL）,the degree of carotid stenosis,carotid intima-media thickness,carotid artery plaque size,hyperuricemia] were analyzed respectively with single factor and multivariate logistic regression analysis to explore the impact on the transformation of bleeding. Results Spontaneous hemorrhagic transformation after ischemic stroke,hemorrhagic transformation of ischemic stroke after thrombolysis,and hemorrhagic transformation after antiplatelet therapy were all associated with neurological deficit scores,infarct volume,duration of diabetes,duration of hypertension,blood of glycosylated hemoglobin concentration,degree of subcortical white matter,LDL,carotid stenosis,carotid artery intima-media thickening,carotid artery plaque size and hyperuricemia.Regression analysis showed that the main risk factors affecting cerebral hemorrhagic transformation were neurological deficit scores,infarct volume,and duration of diabetes and hypertension associated with atrial fibrillation,blood of hemoglobin,LDL and blood uric acid,the degree of subcortical leukoencephalopathy,carotid stenosis,intima thickening,plaque size（ all P〈0. 05）. Conclusion Risk factors should be closely attented when thrombolysis,antithrombotic and anti-platelet or other interventions are im
出处
《中华脑科疾病与康复杂志（电子版）》
2016年第3期129-135,共7页
Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）
基金
广东省科技厅科学技术研究基金立项资助课题(A2009271)
关键词
脑梗死
危险因素
出血性转化
溶栓
抗栓抗血小板
Cerebral infarction
Risk factors
Hemorrhage transformation
Thrombolytic
Antithrombotic antiplatelet
