Analysis of risk factors for hemorrhagic transformation by recombinant tissue plasminogen activator in patients with acute cerebral infarction
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摘要: 目的:探讨急性脑梗死患者静脉应用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后出血转化(HT)的危险因素。方法:回顾性分析2017-01—2018-12期间收治的245例接受rt-PA静脉溶栓治疗的急性脑梗死患者的临床资料,根据溶栓后是否发生出血转化分为HT组与非HT组(NHT组)。收集两组患者一般资料、发病至治疗时间(OTT)、溶栓前美国国立卫生院脑卒中量表(NIHSS)评分、实验室检查指标、影像学特点等资料。应用Logistic回归分析溶栓后出血转化的危险因素。结果:245例接受rt-PA溶栓的急性脑梗死患者发生HT的38例,占15.51%。单因素分析显示,年龄、吸烟史、溶栓前收缩压、溶栓前血糖、糖尿病史、心房颤动史、溶栓前NIHSS评分、OTT、血尿酸、脑白质疏松是急性脑梗死溶栓后HT的影响因素(P<0.05);多因素Logistic回归分析结果显示,糖尿病(OR=0.737,95%CI:0.765~1.048)、溶栓前NIHSS评分(OR=0.590,95%CI:0.428~0.814)、OTT(OR=0.351,95%CI:0.530~1.185)、血尿酸(OR=0.954,95%CI:0.928~0.980)、溶栓前收缩压(OR=0.819,95%CI:0.737~0.910)、脑白质疏松(OR=0.459,95%CI:0.865~0.912)是急性脑梗死溶栓后HT的独立危险因素。结论:糖尿病、溶栓前NIHSS评分、OTT、血尿酸、溶栓前收缩压、脑白质疏松是急性脑梗死溶栓后HT的独立危险因素。因此,临床上针对此类患者进行rt-PA静脉溶栓治疗时应谨慎,避免不良事件的发生。Abstract: Objective:To investigate the risk factors of hemorrhagic transformation(HT) after intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA) in patients with acute cerebral infarction. Method: The clinical data of 245 patients with acute cerebral infarction who underwent rt-PA intravenous thrombolysis from January 2017 to December 2018 were retrospectively analyzed, including 38 patients in the HT group and 207 patients in the NHT group. The general data of the two groups, the time from onset to treatment(OTT), the National Institute of Health Stroke Scale(NIHSS) score before the thrombolysis, laboratory test indicators, imaging characteristics and other data were collected. Logistic regression was used to analyze risk factors for hemorrhagic transformation after thrombolysis. Result: Of the 245 patients with acute cerebral infarction who received rt-PA thrombolysis, 38 patients developed HT, accounting for 15.51%. Univariate analysis showed that age, smoking history, systolic blood pressure before thrombolysis, blood glucose before thrombolysis, history of diabetes, history of atrial fibrillation, NIHSS score before thrombolysis, OTT, blood uric acid, and leukoaraiosis were acute cerebral infarction after thrombolysis. Influencing factors(P<0.05); multivariate Logistic regression analysis showed that diabetes(OR=0.737, 95% CI: 0.765-1.048), pre-thrombotic NIHSS score(OR=0.590, 95%CI: 0.428-0.814), OTT(OR=0.351, 95%CI: 0.530-1.185), blood uric acid(OR=0.954, 95%CI: 0.928-0.980), systolic blood pressure before thrombolysis(OR=0.819, 95%CI: 0.737-0.910), leukoaraiosis(OR=0.459, 95%CI: 0.865-0.912) is an independent risk factor for HT after thrombolysis in acute cerebral infarction.Conclusion: Diabetes, NIHSS score before thrombolysis, OTT, blood uric acid, systolic blood pressure before thrombolysis, and leukoaraiosis are independent risk factors for HT after thrombolysis in acute cerebral infarction. Therefore, clinical caution should be exercised in the treatment of rt-PA intravenous thrombolysis in such patients to avoid adverse events.
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Key words:
- acute ischemic stroke /
- thrombolytic therapy /
- hemorrhagic transformation /
- risk factor
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