摘要
目的：研究并探讨影响后循环脑梗塞溶栓治疗后出现出血性转化的危险因素及与预后相关性。方法：150例后循环梗死患者接受静脉尿激酶（80-150万IU）溶栓治疗,根据是否有出血性转化分成出血性转化组（HT）和非出血性转化组（NHT）两组。观察D-二聚体及纤维蛋白原降解物水平（FDP）、血小板、血糖、血脂等的变化;并采用美国国立卫生研究院卒中量表（NIHSS）、以修正的Rankin指数评分（MRS）评价患者神经功能缺损情况,评价后循环溶栓治疗的远期疗效。并对可能与出血性转化相关的因素进行回归分析。结果：HT的发生率为24%;HT组总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）均显著低于NHT组（P〈0.05）;HT组NIHSS、纤维蛋白原降解物（FDP）、D-二聚体高于NHT组,差异有统计学意义（P〈0.05）。Logistic回归分析显示,NIHSS评分、TC、LDL-C、D-二聚体、纤维蛋白原降解物是发生出血性转化的危险因素（P〈0.05）。尿激酶输注后6h两组患者血浆D-二聚体均有不同程度升高,HT组明显,24h后再次升高。尿激酶输注后12h两组患者FDP水平均下降,而HT组降低最显著。溶栓后90d两组NIHSS评分及MRS评分均较溶栓前明显降低,有统计学差异（P〈0.05）。结论：NIHSS评分、FDP、D二聚体、TC、LDL-C是后循环脑梗死发生出血性转化的危险因素,且溶栓治疗能改善患者远期预后。
Objective： To investigate the related risk factors of hemorrhagic transformation（ HT） in acute posterior circulation infarction and relationship with the prognosis. Method： 150 acute posterior circulation infarction patients accepted thrombolytic therapy. Observed the D- dimer and fibrinogen degradation products（ FDP） level,the change of platelets,blood sugar,blood lipids and so on. Used the NIHSS score,the modified Rankin index score（ MRS） nerve function to evaluate the active ability of daily life of patients,observed long-term effect of patients after thrombolysis. Result： The rate of HT was 24%; Compared with NHT group,total cholesterol（ TC）,low-density lipoprotein cholesterol（ LDL-C）,HT group were much lower,the difference was statistically significant（ P〈0. 05）. NIHSS score,fibrinogen degradation products（ FDP）,D- dimer were higher than NHT group,the difference was statistically significant. Logistic regression analysis showed that NIHSS score,TC,LDL-C,D-dimer,FDP were independent risk factors of HT（ P〈0.05）. After infusing urokinase 6 hours,D-dimer level of two groups was increased,HT group was more significance,and after 24 h,it increased again,fibrinogen degradation products decreased,the lowest point on HT group; Both HT and NHT group＇s NIHSS score and MRS score had significant differences in 90 days（ P0.05）. Conclusion： NIHSS score,FDP,D-dimer,TC,LDL-C are independent risk factors for hemorrhagic transformation.Thrombolysis therapy could improve the long-term prognosis.
出处
《河北医学》
CAS
2015年第8期1426-1429,共4页
Hebei Medicine
基金
广西壮族自治区贵港市自然科学基金
(编号:贵科转1004037)
关键词
缺血性脑卒中
出血性转化
纤维蛋白原降解物
D-二聚体
Acute ischemic stroke
Hemorrhagic transformation
Fibrinogen degradation products
D-dimer
