摘要
目的分析急性缺血性卒中(AIS)不同分型患者溶栓后出血转化的危险因素。方法分析2023年1月至12月于哈尔滨医科大学附属第二医院卒中中心进行溶栓治疗的AIS患者1159例,多因素Logistic回归进行各TOAST亚型的出血转化(HT)危险因素分析。结果多因素分析结果显示,溶栓前美国国立卫生研究院卒中量表(NIHSS)评分(P<0.05)是大动脉粥样硬化型(LAA)患者发生HT的危险因素,血小板计数(P<0.05)、镁离子水平(P<0.05)及三酰甘油水平(P<0.05)是LAA型患者发生HT的保护因素;凝血酶时间(P<0.05)和胆碱酯酶水平(P<0.05)是心源性栓塞型(CE)患者发生HT的保护因素;溶栓前NIHSS评分(P<0.05)、乳酸脱氢酶水平(P<0.05)和心房颤动病史(P<0.05)是小动脉闭塞型(SAO)患者发生HT的危险因素,平均红细胞血红蛋白量(P<0.05)是SAO型患者发生HT的保护因素。结论不同病因分型AIS患者溶栓后HT的危险因素各不相同,较高的溶栓前NIHSS评分是LAA型和SAO型的独立危险因素,较高的乳酸脱氢酶水平和心房颤动病史是SAO型的独立危险因素,为后续研究发生HT的预防和治疗提供思路。
Objective To analyze the risk factors of hemorrhagic transformation after thrombolysis in patients with different types of acute ischemic stroke(AIS).Methods A retrospective analysis was performed on 1159 patients with AIS who were treated with thrombolysis in the Stroke Center of the Second Affiliated Hospital of Harbin Medical University from January 2023 to December 2023.Multivariate logistic regression was used to analyze the risk factors of hemorrhagic transformation(HT)in each TOAST subtype.Results The results of multivariate analysis showed that the National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis(P<0.05)was a risk factor for HT in patients with large atherosclerosis type(LAA).Platelet count(P<0.05),magnesium ion level(P<0.05)and triglyceride level(P<0.05)were the protective factors for HT in LAA patients.Thrombin time(P<0.05)and cholinesterase(P<0.05)were the protective factors for HT in patients with cardiac embolization type(CE).Pre-thrombolysis NIHSS score(P<0.05),lactate dehydrogenase level(P<0.05)and atrial fibrillation history(P<0.05)were risk factors for HT in patients with small artery occlusion type(SAO),and mean erythrocyte hemoglobin content(P<0.05)were protective factors for HT in patients with SAO type.Conclusion Higher pre-thrombolysis NIHSS score is an independent risk factor for LAA type and SAO type,and higher lactate dehydrogenase level and atrial fibrillation history are independent risk factors for SAO type,which provides ideas for the prevention and treatment of HT in follow-up research.
作者
李薇
孔晓彤
王丽华
Li Wei;Kong Xiaotong;Wang Lihua(Department of Neurology,the Second Afiliated Hospital,Harbin Medical University,Heilongjiang 150086,China)
出处
《脑与神经疾病杂志》
2025年第8期484-490,共7页
Journal of Brain and Nervous Diseases
基金
黑龙江省中医药管理局科技计划青年中医药科研课题(ZHY2024-249)。
关键词
缺血性卒中
溶栓
出血转化
危险因素
Ischemic stroke
Thrombolysis
Hemorrhagic transformation
Risk factors
