摘要
目的:探讨出血性转化(hemorrhagic transformation,HT)及其不同亚型对急性缺血性卒中(acute ischemic stroke,AIS)患者临床转归的影响。方法:回顾性纳入2018年1月至2021年1月河南省人民医院收治的发病24 h内的AIS患者。HT定义为AIS发病后7 d内CT复查发现的颅内出血,并参考欧洲急性卒中协作研究(European Cooperative Acute Stroke Study,ECASS)-Ⅱ分型标准进一步分为出血性梗死(hemorrhagic infarction,HI)和脑实质血肿(parenchymal hematoma,PH)。在发病后90 d时采用改良Rankin量表进行转归评价,0~2分定义为转归良好,3~5分定义为转归不良。应用多变量logistic回归分析确定转归的独立影响因素。结果:共纳入822例患者,男性478例(58.2%),年龄(60.6±10.6)岁,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分中位数8分(四分位数间距6~12分)。282例(34.4%)发生HT,447例(54.4%)转归不良。多变量logistic回归分析显示,PH-1[优势比(odds ratio,OR)2.461,95%置信区间(confidence interval,CI)1.285~4.712;P=0.007]、PH-2(OR 5.291,95%CI 1.178~23.758;P=0.030)、入院时血糖(OR 1.063,95%CI 1.018~1.109;P=0.005)以及基线NIHSS评分(OR 1.124,95%CI 1.076~1.175;P<0.001)是转归不良的独立影响因素。结论:不同HT亚型对AIS患者转归的影响有所不同,其中PH-1和PH-2是转归不良的独立危险因素。
Objective:To investigate the effect of hemorrhagic transformation(HT)and its different subtypes on the clinical outcome of patients with acute ischemic stroke(AIS).Methods:Patients with AIS within 24 h of onset treated in Henan Provincial People's Hospital from January 2018 to January 2021 were retrospectively enrolled.HT was defined as intracranial hemorrhage found by CT reexamination within 7 d after the onset of AIS,and further divided into hemorrhagic infarction(HI)and parenchymal hematoma(PH)according to the classification standard of European Cooperative Acute Stroke Study(ECASS)-Ⅱ.The modified Rankin Scale was used to evaluate the outcome at 90 d after onset.0-2 was defined as good outcome and 3-5 were defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of the outcomes.Results A total of 822 patients were enrolled,including 478 males(58.2%),aged 60.6±10.6 years.The median score of the baseline National Institutes of Health Stroke Scale(NIHSS)was 8(interquartile range:6-12).Two hundred and eighty-two patients(34.4%)developed HI and 447(54.4%)had poor outcomes.Multivariate logistic regression analysis showed that PH-1(odds ratio[OR]2.461,95%confidence interval[Cl]1.285-4.712;P=0.007),PH-2(OR 5.291,95%Cl 1.178-23.758;P=0.030),blood glucose at admission(OR 1.063,95%CI 1.018-1.109;P=0.005)and baseline NIHSS score(OR 1.124,95%Cl 1.076-1.175;P<0.001)were the independent influencing factors of the poor outcomes.Conclusion Different HT subtypes have different effects on the outcomes of patients with AIS,among which PH-1 and PH-2 are the independent risk factors for poor outcomes.
作者
刘娜
赵建华
鲍婕妤
张静
蔡萌萌
Liu Na;Zhao Jianhua;Bao Jieyu;Zhang Jing;Cai Mengmeng(Peoples Hospital of Henan University,Zhengzhou 450003,China;Department of Neurology,Henan Provincial People's Hospital,Zhengzhou 450003,China)
出处
《国际脑血管病杂志》
2022年第2期94-98,共5页
International Journal of Cerebrovascular Diseases
基金
河南省医学科技公关计划项目(SBGJ2018075)。
关键词
卒中
脑缺血
脑出血
治疗结果
危险因素
Stroke
Brain ischemia
Cerebral hemorrhage
Treatment outcome
Risk factors
