摘要
目的分析CT灌注成像与急性缺血性脑卒中(ACI)溶栓治疗后出血转化(HT)的相关性及影响因素。方法将安徽医科大学附属巢湖医院2019-06—2021-06收治的56例ACI静脉溶栓治疗后发生HT的患者纳入HT组,同期行溶栓治疗未发生HT的150例患者纳入NHT组,所有患者均进行灌注CT检查,并记录灌注参数,统计2组患者预后。将年龄、性别、基础疾病、溶栓至发病时间等可能与HT相关的因素纳入Logistic回归方程,分析影响ACI患者溶栓后发生HT的独立因素。结果HT组患者的表面通透性(PS)明显高于NHT组,脑血容量(CBV)和脑血流量(CBF)明显低于NHT组,差异均有统计学意义(P<0.05)。HT组患者预后不良发生率高于NHT组,差异有统计学意义(P<0.05)。以ACI患者溶栓术后是否并发HT作为因变量Y(发生HT=1,未发生HT=0),单因素分析中有统计学差异的指标为自变量,行二元Logistic回归分析,提示房颤(OR=3.080,95%CI:1.597~5.939)、溶栓前NIHSS评分(OR=2.779,95%CI:1.709~4.518)、血糖(OR=1.489,95%CI:1.198~1.851)、发病至溶栓时间(OR=1.745,95%CI:1.154~2.639)是ACI患者静脉溶栓后并发HT的独立危险因素,血尿酸(OR=0.649,95%CI:0.516~0.816)是其保护因素。结论CT灌注成像参数与ACI溶栓后HT关系密切。ACI溶栓术后并发HT者预后不良发生率高,HT者预后不良风险大,而合并房颤、溶栓前NIHSS评分高、高血糖水平、发病至溶栓时间过长均是静脉溶栓后并发HT的独立危险因素,高血尿酸水平是其保护因素。
Objective To analyze the correlation between CT perfusion imaging and hemorrhagic transfor⁃mation(HT)after thrombolytic therapy in acute ischemic stroke(ACI)and its related influencing factors.Methods Fifty-six patients who developed HT after ACI intravenous thrombolysis treatment admitted to Chaohu Hospital Affiliated with Anhui Medical University from June 2019 to June 2021 were included in the HT group.Totally 150 patients who underwent thrombolysis treatment at the same time but did not develop HT were included in the NHT group.All patients underwent perfusion CT examination and recorded perfusion parameters,and the prognosis of patients in the two groups was statistically analyzed.Incorporate factors such as age,gender,underlying disease,and time from thrombolysis to onset that may be related to HT into the Logistic regression equation to analyze independent factors that affect the occurrence of HT in ACI patients after thrombolysis.Results The sur⁃face permeability(PS)of the HT group patients was significantly higher than that of the NHT group,and the cere⁃bral blood volume(CBV)and cerebral blood flow(CBF)were significantly lower than those of the NHT group,with statistical significance(P<0.05).The incidence of poor prognosis in the HT group was higher than that in the NHT group,and the difference was statistically significant(P<0.05).Using the incidence of postoperative HT in ACI patients as the dependent variable Y(concurrent HT=1,non-concurrent HT=0),and the significant indica⁃tors in univariate analysis as the independent variable,binary Logistic regression analysis showed that atrial fibril⁃lation(OR=3.080,95%CI:1.597-5.939),pre-thrombolytic NIHSS(OR=2.779,95%CI:1.709-4.518),blood glu⁃cose(OR=1.489,95%CI:1.198-1.851),the time from onset to thrombolysis(OR=1.745,95%CI:1.154-2.639)were independent risk factors for HT in ACI patients after intravenous thrombolysis,and blood uric acid(OR=0.649,95%CI:0.516-0.816)was a protective factor.Conclusion The parameters of CT perfusion imaging are closel
作者
刘伟
黄泽玉
宫立新
刘云峰
LIU Wei;HUANG Zeyu;GONG Lixin;LIU Yunfeng Chaohu(Hospital Affiliated to Anhui Medical University/Anhui Psychiatric Center,Chaohu 238000,China)
出处
《中国实用神经疾病杂志》
2023年第7期836-841,共6页
Chinese Journal of Practical Nervous Diseases
基金
安徽省高等学校科学研究项目(编号:2022AH050759)。
关键词
急性缺血性脑卒中
CT灌注成像
溶栓治疗
预后
出血转化
Acute ischemic stroke
CT perfusion imaging
Thrombolytic therapy
Prognosis
Hemorrhagic transformation
