摘要
目的探讨心房颤动与急性缺血性卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓致出血转化的相关性,分析房颤患者溶栓后出血转化的危险因素。方法回顾性分析接受rt-PA静脉溶栓治疗的147例急性缺血性卒中患者,将入选病例分为非房颤组与房颤组,比较两组患者溶栓后出血转化(HT)的差异,采用单因素和logistic回归分析房颤患者溶栓后出血转化的危险因素。结果 147例入组患者中房颤患者66例,非房颤患者81例,房颤组HT与非房颤组比较差异有统计学意义[27.27%(18/66)与14.81%(12/81),χ2=3.071,P=0.028],房颤组症状性HT与非房颤组比较差异亦有统计学意义[12.12%(8/66)与3.70%(3/81),χ2=3.798,P=0.015],logistic回归分析表明伴发房颤的患者基线收缩压高(OR=11.285,95%CI 1.576-68.377,P=0.035)、基线NIHSS评分较高(OR=2.608,95%CI 1.072-4.380,P=0.013)、早期头部CT有缺血改变(OR=1.595,95%CI 1.164-3.258,P=0.023)、起病-溶栓时间(OTT)较长(OR=93.114,95%CI 7.385-177.972,P=0.006)、溶栓24h内血压变异性大(收缩压变异性OR=18.638,95%CI 1.433-65.634,P=0.004;舒张压变异性OR=21.449,95%CI 1.528-56.420,P=0.003)与溶栓后发生HT显著相关。结论房颤与静脉溶栓后HT具有相关性。基线收缩压高、基线NIHSS评分较高、早期头部CT有缺血改变、OTT较长、溶栓24h内血压变异性大是房颤患者静脉溶栓后发生HT的危险因素。
Objective To explore the relation between atrial fibrillation and hemorrhagic transformation（HT） which is the result of the intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）. To investigate the risk factors for HT after intravenous thrombolysis in patients with atrial fibrillation. Methods 147 patients with acute ischemie stroke after intravenous thrombolysis with rt-PA were consecutively recruited. Patients were divided into the non-fibrillation atrial or fibrillation atrial group. To compare the difference in HT between the two groups. Single factor and logistic regres- sion were used to analyze the risk factors of HT in patients with atrial fibrillation after thrombolytic treatment. Results There were 66 cases with atrial fibrillation in all, and 81 cases were non-atrial fibrillation. The proportions of HT were sig- nificantly different between two groups[ 27.27% （18/66） 与 14.81% （ 12/81 ） ,X2 = 3. 071 ,P = 0. 028 ~, as well as symp- tomatic intracerebral hemorrhage （SICH） [ 12.12% （ 8/66 ） 与 3.70% （ 3/81 ） ,X2 = 3. 798, P = 0.0151. Logistic regression showed high baseline systolic blood pressure （ OR = 11. 285,95% CI 1. 576-68. 377,P = 0. 035 ）, high baseline NIHSS score （ OR = 2. 608,95 % CI 1. 072-4. 380, P = 0.013 ）, early ischemic changes （EICs） on brain CT （ OR = 1. 595,95 % CI 1.164- 3. 258, P = 0.023 ） , long onset to treatment time （OTF） （ OR = 93.114,95 % C/7. 385-177. 972, P = 0. 006 ） and large blood pressure variability （ systolic pressure variability ： OR = 18. 638,95 % CI 1. 433-65. 634, P = 0. 004 ; diastolic pressure varia- bility ： OR = 21. 449,95% CI 1. 528-56. 420 ,P = 0. 003 ） were related to HT independently in patients with atrial fibrillation. Conclusion HT after intravenous thrombolysis was relevant to atrial fibrillation. High baseline systolic blood pressure, high baseline NIHSS score, EICs on brain CT, long Oq＇T and large blood pressure variability were risk factors for HT after intravenous thrombolvsis in natients with atrial fibrillation.
出处
《中风与神经疾病杂志》
CAS
北大核心
2015年第5期415-418,共4页
Journal of Apoplexy and Nervous Diseases
关键词
缺血性卒中
心房颤动
静脉溶栓
出血转化
危险因素
Ischemic stroke
Atrial fibrillation
Intravenous thrombolysis
Hemorrhagic transformation
Risk factors
