摘要
目的探讨急性脑梗死患者梗死体积、梗死分型、炎症及凝血指标对出血转化的影响。方法回顾性分析2018年12月至2019年12月首都医科大学附属北京天坛医院收治的711例急性脑梗死患者的临床资料、炎症及凝血功能等实验室指标水平,记录患者梗死部位、体积及梗死分型等信息,并根据住院期间是否发生出血转化分为出血转化组(85例)和非出血转化组(626例)。符合正态分布的计量资料以x±s表示,偏态分布的计量资料以M(Q_(1),Q_(3))表示,分类变量以例(%)表示。计量资料采用独立样本t检验或Mann-WhitneyU检验进行组间比较;采用χ^(2)检验比较分类变量。分别采用单因素比较及多因素Logistic回归分析急性脑梗死患者发生出血转化的危险因素,应用受试者工作特征曲线分析各指标的预测价值。结果出血转化组患者冠心病和心房颤动病史的比例分别为23.5%(20/85)和22.4%(19/85),显著高于非出血转化组的13.9%(87/626)和5.8%(36/626),两组间比较差异均有统计学意义(χ^(2)值分别为5.43、28.90,P值分别为0.020、<0.001)。出血转化组患者美国国立卫生研究院卒中量表评分[10(4,17)分]和梗死体积[46.50(14.21,118.42)mL]均明显高于非出血转化组[4(2,7)分,2.00(0.51,8.94)mL],两组间比较差异均有统计学意义(Z值分别为6.69、10.69,均P<0.001)。多因素Logistic回归分析结果显示,心房颤动(OR=2.604,95%CI:1.186~5.716,P=0.017)、梗死体积(OR=1.009,95%CI:1.004~1.015,P=0.001)、中国缺血性卒中亚型为心源性脑栓塞型(OR=1.371,95%CI:1.085~1.731,P=0.008)、中性粒细胞/淋巴细胞比值(OR=1.047,95%CI:1.006~1.090,P=0.023)是出血转化的独立危险因素。受试者工作特征曲线分析显示,梗死体积和中性粒细胞/淋巴细胞比值的曲线下面积分别为0.861(0.821~0.901)和0.684(0.626~0.741),均具有预测急性脑梗死后出血转化的效能,其中梗死体积的预测效能更高。结论心房颤动病史、心源性脑栓塞分型、梗死体积和中性粒细胞/淋巴细胞比值均为急性脑梗死后出血转化的危险因素。
Objectives To explore the effects of infarct volume,infarct type,inflammation,and coagulation indicators on hemorrhagic transformation in patients with acute cerebral infarction.Methods 711 patients with cerebral infarction admitted to Beijing Tiantan Hospital were retrospectively included as the study objects from December 2018 to December 2019[535 males and 176 females,age 22-95 years,mean age(59.6±12.1)years].Clinical data,laboratory indicators such as inflammation and coagulation function of patients were collected,and information such as location,volume and type of infarction were recorded.The patients were divided into hemorrhage transformation group and non-hemorrhage transformation group according to whether hemorrhage transformation occurred during hospitalization.Normally distributed measurement data were expressed as x±s,non-normally distributed measurement data were expressed as median and quartiles[M(Q_(1),Q_(3))],categorical variable were expressed as ratio and percent(%).Comparison between groups of measurement data were performed by independent sample t test and Mann-Whitney U test.χ^(2)test were used on comparison between groups of categorical variable.Univariate comparison and multivariate Logistic regression were used to analyze the correlation between hemorrhage transformation and infarct volume,infarction type and laboratory indicators,respectively,to explore the risk factors of hemorrhage transformation.ROC curve analysis was used to evaluate the diagnostic value of indicators.Results The rates of coronary heart disease and atrial fibrillation history in the hemorrhage transformation group were 23.5%(20/85)and 22.4%(19/85),respectively,which were significantly higher than those in the non-hemorrhage transformation group(13.9%(87/626)and 5.8%(36/626),respectively),and the difference between the two groups was statistically significant(χ^(2)=5.43,χ^(2)=28.90,P=0.020,P<0.001,respectively).The NIHSS score[10(4,17)points]and infarct volume[46.50(14.21,118.42)mL]in the hemorrhage transformation group were significantly higher than those in the non-hemorrhage transformation group[4(2,7)points,2.00(0.51,8.94)mL].The difference between the two groups was statistically significant(Z values were 6.69 and 10.69,respectively,P<0.001).The results of multivariate Logistic regression analysis showed that atrial fibrillation(OR=2.604,95%CI:1.186-5.716,P=0.107),infarct volume(OR=1.009,95%CI:1.004-1.015,P=0.001),infarct type of Chinese ischemic stroke subclassfication(OR=1.371,95%CI:1.085-1.731,P=0.008)and neutrophil/lymphocyte ratio(OR=1.047,95%CI:1.006-1.090,P=0.023)were independent risk factors for hemorrhage transformation.ROC curve analysis showed that the area under curve(AUC)of infarct volume and neutrophil/lymphocyte ratio were 0.861(0.821-0.901)and 0.684(0.626-0.741),respectively,which were effective in predicting hemorrhage transformation after cerebral infarction.The prediction of infarct volume was more efficient.Conclusion History of atrial fibrillation,classification of cardioembolic stroke,infarct volume,and neutrophil/lymphocyte ratio are all risk factors for hemorrhagic transformation after acute cerebral infarction.
作者
张丽敏
吴建维
王丹
孙越红
张晨曦
刘紫薇
许惠文
赵运转
Zhang Limin;Wu Jianwei;Wang Dan;Sun Yuehong;Zhang Chenxi;Liu Ziwei;Xu Huiwen;Zhao Yunzhuan(Laboratory Department,Beijing Tiantan Hospital,Capital Medical University,Beijing Engineering Research Center of Immunological Reagents Clinical Research,National Medical Products Administration,Key Laboratory for Quality Control of In Vitro Diagnostics,Beijing 100070,China;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中国综合临床》
2025年第4期260-266,共7页
Clinical Medicine of China
基金
北京市医管中心“扬帆计划”(ZYLX202108)。
关键词
脑梗死
出血转化
梗死体积
心源性脑栓塞
中性粒细胞
Cerebral infarction
Hemorrhagic transformation
Infarct volume
Cardiac cerebral embolism
neutrophil
