摘要
目的分析影响急性缺血性脑卒中(AIS)行重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后患者神经功能恢复及脑出血转化(HT)发生的危险因素。方法选择2018年3月至2020年1月在徐州医科大学附属常熟医院接受rt-PA溶栓的173例AIS患者作为研究对象,按是否发生HT将患者分为HT组(46例)和非HT组(127例)。收集患者性别、年龄、体量指数(BMI)、既往史(包括吸烟史、饮酒史、高血压、糖尿病、脑卒中史、心房颤动、冠心病)、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓前收缩压、溶栓前舒张压、血红蛋白、血糖、三酰甘油、总胆固醇、溶栓时间、责任梗死、CT低密度灶及估算的肾小球滤过率(eGFR)、血尿酸(SUA)、纤维蛋白原(Fib)等资料,比较是否发生HT组和不同预后患者上述指标的差异;采用多因素Logistic回归分析影响HT发生和患者神经功能恢复的因素。结果①单因素分析显示,HT组eGFR(mL·min^(-1)·1.73 m^(-2):87.53±14.32比121.47±32.49)、SUA(μmol/L:324.89±70.43比383.08±89.21)均明显低于非HT组(均P<0.05),Fib(g/L:2.99±0.57比2.58±0.49)、年龄(岁:70.32±5.87比65.28±7.09)、高血压比例〔76.1%(35/46)比51.2%(65/127)〕、糖尿病〔71.7%(33/46)比48.8%(62/127)〕、溶栓前NIHSS(分:13.42±2.97比10.18±1.85)、溶栓时间3.0~4.5 h比例〔52.2%(24/46)比38.6%(49/127)〕、CT低密度灶比例〔50.0%(23/46)比22.0%(28/127)〕均明显高于非HT组(均P<0.05);预后不良组eGFR(mL·min^(-1)·1.73 m^(-2):92.08±22.37比116.59±24.57)、SUA(μmol/L:332.58±59.03比370.34±63.46)均明显低于预后良好组(均P<0.05),Fib(g/L:2.91±0.46比2.68±0.52)、年龄(岁:71.26±5.42比64.08±7.48)、BMI(kg/m^(2):24.32±3.68比23.18±3.16)和高血压比例〔69.7%(46/66)比50.5%(54/107)〕、溶栓前NIHSS(分:12.98±3.02比10.32±2.14)、溶栓时间3.0~4.5 h比例〔57.6%(38/66)比32.7%(35/107)〕、CT低密度灶比例〔40.9%(27/66)比22.4%(24/107)〕均明显高于预后良�
Objective To analyze the risk factors of neurological function recovery and occurrence of cerebral hemorrhage transformation(HT)after recombinant tissue-type plasiminogen activator(re-PA)in patients with acute ischemic stroke(AIS).Methods The 173 patients with AIS who received rt-PA thrombolysis in Changshu Hospital of Xuzhou Medical University from March,2018 to January,2020 were selected as research objects,and they were divided into HT group(46 cases)and non HT group(127 cases)according to whether HT occurred.The data such as gender,age,body mass index(BMI),past histories including smoking,drinking,hypertension,diabetes mellitus,stroke,atrial fibrillation,coronary heart disease,National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis,systolic blood pressure before thrombolysis,diastolic blood pressure before thrombolysis,hemoglobin,blood glucose,triglyceride,total cholesterol,thrombolytic time,responsible infarction,CT low density foci,estimated glomerular filtration rate(eGFR),serum uric acid(SUA)and fibrinogen(Fib)were collected.The differences of the above indexes were compared between the HT and non HT groups and the patients with different prognosis.The factors influencing the occurrence and neurological function recovery of HT were analyzed by multivariate Logistic regression.Results①Univariate analysis showed that eGFR(mL·min^(-1)·1.73 m^(-2)):87.53±14.32 vs.121.47±32.49)and SUA(μmol/L:324.89±70.43 vs.383.08±89.21)in HT group were significantly lower than those in non HT group(both P<0.05),Fib(g/L:2.99±0.57 vs.2.58±0.49),age(years old:70.32±5.87 vs.65.28±7.09),hypertension[76.1%(35/46)vs.51.2%(65/127)],diabetes mellitus[71.7%(33/46)vs.48.8%(62/127)],NIHSS before thrombolysis(13.42±2.97 vs.10.18±1.85),proportion of thrombolytic time 3.0-4.5 hours[52.2%(24/46)vs.38.6%(49/127)],and the proportion of CT low-density lesions[50.0%(23/46)vs.22.0%(28/127)]in HT group were significantly higher than those in non HT group(all P<0.05).In poor prognosis group,eGFR(mL·min^(-1)·1.73
作者
陈燕
张秋
尤年兴
王利平
Chen Yan;Zhang Qiu;You Nianxing;Wang Liping(Department of Neurology,Changshu Hospital of Xuzhou Medical University,Changshu Second People's Hospital,Changshu 215501,Jiangsu,China;Department of Internal Medicine,Xushi Hospital of Changshu City,Changshu 215501,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第11期1340-1345,共6页
Chinese Critical Care Medicine
关键词
缺血性脑卒中
重组组织型纤溶酶原激活剂
估算的肾小球滤过率
尿酸
纤维蛋白原
出血转化
Ischemic stroke
Recombinant tissue-type plasiminogen activator
Estimated glomerular filtration rate
Uric acid
Fibrinogen
Hemorrhagic transformation
