摘要
目的：明确合并颅内微出血对急性缺血性卒中患者静脉重组组织型纤溶酶原激活剂（rt-PA）溶栓后的出血转化以及3个月后神经功能结局的影响.方法：连续收集225例2009年6月至2013年5月期间在浙江大学医学院附属第二医院神经内科接受静脉rt-PA溶栓治疗并行磁敏感序列检查的急性缺血性卒中患者的临床及实验室检查资料,评估患者溶栓后出血转化情况及3个月改良Rankin量表,在磁敏感序列上评估微出血严重程度.采用多元logistic回归分析出血转化,以无出血转化为参照,分析不同出血转化类型的影响因素;采用二元logistic回归分析症状性出血与神经功能结局的影响因素.结果：225例患者平均年龄（66 29±13 01）岁,女性73例（32 4%）,发病至溶栓时间为（238 40±89 16）min,溶栓前美国国立卫生研究院卒中量表（NIHSS）评分为（11 40±5 89）分;共91例（36 1%）合并颅内微出血,微出血数目总计522个;共64例（28 4%）发生溶栓后出血转化,其中43例（19 1%）为出血性脑梗死型,21例（9 3%）为脑实质血肿型.多元logistic回归分析结果提示,多发（≥3个）颅内微出血增加溶栓治疗后脑实质血肿型出血转化（OR=4 957,95%CI 1 306~18 811,P=0 019）.二元logistic回归分析结果提示,多发（≥3个）颅内微出血是溶栓治疗后神经功能不良的独立危险因素（OR=3 496,95%CI 1 381~8 849,P=0 008）.结论：多发（≥3个）颅内微出血增加急性缺血性卒中患者静脉rt-PA溶栓后的脑实质血肿型出血转化风险,并与溶栓治疗后3个月不良神经功能结局有关.
Objective： To assess the impact of cerebral microbleeds （CMBs） on clinical outcomes in patients with acute ischemic stroke treated by intravenous thrombolysis. Methods： The clinical data of 225 patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator therapy in the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2009 to May 2013 were reviewed. The severity of CMBs and hemorrhagic transformation （HT） after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale （mRS） at 3 months were evaluated. Favorable outcome was defined as mRS 0-1 and unfavorable outcome as mRS 2-6. Multivariate logistic-regression analysis and binary logistic-regression were used to determine independent risk factors of HT and favorable outcome. Results： The mean age of 225 patients was （66.29 ± 13.01 ） y, 73 （32.4%） patients were women, mean pretreatment National Institutes of Health Stroke Scale （NIHSS） score was 11.40± 5.89, and onset-to-needle time was （238.40± 89. 16） min. Totally, 522 CMBs were detected in 91 patients （36. 1% ）. Postlytic radiological HT was found in 64 patients （28.4%）, among which 43 （ 19.1% ） were hemorrhagic infarction and 21 （9. 3% ） were parenchymal hematoma. Univariate analysis showed that patients with HT had higher NIHSS score and more incidence of atrial fibrillation and that patients with unfavorable outcome were older and had higher NIHSS score and more CMBs. Multivariate logistic regression analysis showed that multiple CMBs （ ≥3 ） was independently associated with parenchymal hematoma （OR =4. 957, 95% CI 1. 306-18. 811, P = 0. 019）, but not with hemorrhagic infarction （ OR = 1. 204, 95% CI 0. 386-3. 754, P = 0. 749）. Binary logistic regression analysis showed that multiple CMBs （〉/3 ） was independently associated with unfavorable outcome （OR = 3. 496, 95% CI 1. 381-8. 849, P = 0. 008）. Conclusion： Multiple CMBs are correlated with parenchymal hematoma and unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.
出处
《浙江大学学报（医学版）》
CAS
CSCD
北大核心
2014年第1期20-27,共8页
Journal of Zhejiang University(Medical Sciences)
基金
浙江省杰出青年科学基金(LR12H09001)
浙江省科技厅重大科技专项计划(2013C13G2010032)
