摘要
目的分析急性缺血性脑卒中(acute ischemic stroke,AIS)患者行重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)静脉溶栓后出血转化的影响因素。方法选择2017年6月—2020年6月于郑州大学第一附属医院神经内科住院并接受rt-PA静脉溶栓治疗的AIS患者。根据患者是否发生出血转化分为出血转化组和未出血转化组。收集患者年龄、性别、既往史、溶栓前美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、相关生化检查指标等一般资料。分析出血转化组与未出血转化组患者间的差异,并分析影响AIS患者静脉溶栓后出血转化的相关因素。结果共纳入患者323例。其中,发生出血转化46例(14.2%),未发生出血转化277例(85.8%)。除游离三碘甲状腺原氨酸(serum free triiodothyronine,FT3)、房颤、高血压、脑梗死面积、溶栓前NIHSS评分、尿酸、溶栓前血糖、白细胞计数、白蛋白水平、谷丙转氨酶、谷草转氨酶/谷丙转氨酶和C反应蛋白水平的比较差异均有统计学意义(P<0.05)外,其余指标两组比较差异均无统计学意义(P>0.05)。Logistic回归分析显示,溶栓前NIHSS评分≥13分、谷草转氨酶/谷丙转氨酶、溶栓前血糖≥12.74 mmol/L、低FT3水平、大面积脑梗死、房颤是AIS溶栓后出血转化的独立危险因素。结论FT3及谷草转氨酶/谷丙转氨酶水平可能是预测静脉溶栓后出血转化的较好的生物标志物。对于白蛋白和尿酸水平降低的患者,外源性尿酸和白蛋白的补充可能有助于减小AIS溶栓后出血转化的风险。
Objective To analyze the influencing factors of hemorrhagic transformation(HT)after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)in patients with acute ischemic stroke(AIS).Methods AIS patients hospitalized in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University between June 2017 and June 2020 and receiving rt-PA intravenous thrombolysis were selected.Patients were divided into two groups according to whether they had HT,HT group and non-HT group.General data such as patient’s age,sex,past history,score of National Institute of Health Stroke Scale(NIHSS)before thrombolysis,and related biochemical examination indicators were collected,to analyze the difference between the patients with HT or not,and analyze the related factors affecting the HT of AIS patients after intravenous thrombolysis.Results A total of patients 323 were included.Among them,46 cases(14.2%)had HT,and 277 cases(85.8%)had no-HT.Except for serum free triiodothyronine(FT3),atrial fibrillation,hypertension,cerebral infarction area,NIHSS score before thrombolysis,uric acid,blood glucose before thrombolysis,white blood cell count,albumin level,alanine aminotransferase,aspartate aminotransferase/alanine aminotransferase and C-reactive protein(P<0.05),there was no significant difference in other indexes between the two groups(P>0.05).Logistic regression analysis showed that NIHSS score≥13 before thrombolysis,aspartate aminotransferase/alanine aminotransferase,blood glucose before thrombolysis≥12.74 mmol/L,low FT3 level,massive cerebral infarction,and atrial fibrillation were independent risk factors for HT after thrombolysis in AIS.Conclusions FT3 and aspartate aminotransferase/alanine aminotransferase levels may be good biomarkers for predicting HT after intravenous thrombolysis.For patients with reduced albumin and uric acid levels,supplementation of exogenous uric acid and albumin may help reduce the risk of HT after AIS thrombolysis.
作者
张丽
杨伟民
李梦杰
张卓
ZHANG Li;YANG Weimin;LI Mengjie;ZHANG Zhuo(Department of Neurology,the First Affiliate Hospital of Zhengzhou University,Zhengzhou,Henan 45000,P.R.China)
出处
《华西医学》
CAS
2022年第12期1798-1804,共7页
West China Medical Journal
基金
国家自然科学基金(U2004106)
河南省高等学校重点科研项目(21A320039)。
关键词
急性脑卒中
缺血性
溶栓
出血转化
影响因素
Acute stroke
ischemia
thrombolysis
hemorrhagic transformation
influencing factors
