HAT、SEDAN评分及相关脑血管病危险因素预测急性缺血性卒中溶栓后出血性转化临床研究

目的探讨溶栓后出血评分(HAT)、症状性溶栓出血危险因素评分(SEDAN)和相关危险因素预测急性缺血性卒中患者重组组织型纤溶酶原激活物(rt-PA)静脉溶栓后出血性转化的临床应用价值。方法共143例发病4.50 h内行rt-PA静脉溶栓且临床资料完整的急性缺血性卒中患者,根据溶栓治疗后头部CT所示分为出血性转化组(18例)和非出血性转化组(125例),二分类Logistic回归分析筛选静脉溶栓后发生出血性转化的危险因素、受试者工作特征(ROC)曲线评价HAT和SEDAN评分预测出血性转化的敏感性和特异性。结果单因素Logistic回归分析显示,心房颤动、入院时收缩压和血糖水平、发病早期CT呈低密度征象、溶栓时间窗、美国国立卫生研究院卒中量表(NIHSS)评分、HAT和SEDAN评分均为静脉溶栓后出血性转化危险因素(P0.05);代入二分类Logistic回归方程后,除发病早期CT呈低密度征象,其余各项均为静脉溶栓后发生出血性转化之危险因素。ROC曲线显示,HAT评分预测出血性转化灵敏度为94.40%、特异度为41.60%、曲线下面积0.70,SEDAN评分则为94.40%、65.62%和0.77。结论心房颤动、入院时收缩压和血糖水平、溶栓时间窗、NIHSS评分、HAT和SEDAN评分均为缺血性卒中静脉溶栓后发生出血性转化的危险因素,但以SEDAN评分预测价值较高。     

缺血性卒中出血性转化36例临床分析

目的探讨缺血性卒中出血性转化(HT)的临床特点和影响因素。方法分析36例HT的临床资料。结果 HT多发生在发病后7~14 d,最常见于心源性脑栓塞及大面积脑梗死,其次与高血压、高血糖、溶栓、抗凝等有关。结论 HT的发生与病因、危险因素明显相关。对于存在高危因素病人,避免应用溶栓、抗凝等药物,在发病高峰期严密观察病情变化,及时复查头颅CT或MRI,及时调整治疗方案。     

未溶栓急性脑梗死发生出血转化的危险因素分析

目的分析急性脑梗死后非溶栓患者发生出血转化的危险因素。方法选取2013-11—2015-01平顶山一矿职工医院收治的急性脑梗死患者88例为研究对象,均未行溶栓治疗,按是否发生出血性转化将其分为观察组和对照组各44例,回顾性分析其临床资料,如既往疾病史、实验室检查、体检与治疗方式等,实验室指标包括纤维蛋白原(FIB)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC),收缩压、舒张压、脉压(收缩压与舒张压之差),对可能导致急性脑梗死患者发生自发性出血性转化的危险因素进行单因素及多因素Logistic回归分析。结果单因素分析显示观察组年龄≥60岁(61.36%)、吸烟史43.18%、心房颤动70.45%、脑白质病变63.64%、抗凝治疗56.82%、大面积脑梗死72.73%比例高于对照组(P均0.05),实验室检查指标显示观察组FIB(3.93±0.54)g/L、LDL-C(2.03±0.64)mmol/L、TC(3.84±0.25)mmol/L低于对照组(P均0.05),观察组脉压(58.74±3.57)mmHg、NIHSS评分(15.84±1.82)分高于对照组(P均0.05);多因素Logistic回归分析结果显示大面积脑梗死、抗凝治疗、脉压、TC水平是急性脑梗死后非溶栓患者发生出血性转化的独立危险因素。结论大面积脑梗死、抗凝治疗、脉压、TC是急性脑梗死后非溶栓患者发生出血性转化的独立危险因素,临床应予以重视。     

脑梗死出血性转化的相关危险因素分析

目的对脑梗死出血性转化(HT)发生的相关危险因素进行分析探讨,为今后的临床诊治工作提供参考依据。方法随机抽取在2008-03—2011-07我院收治的脑梗死出血性转化病例52例及同期收治的脑梗死未发生出血性转化者50例作为研究对象,回顾性分析2组患者的临床资料。结果经统计发现,HT患者中患有原发性高血压39例,心房纤颤24例,大面积脑梗死44例,脑栓塞28例,以上各种疾病发生率均较非HT组高(P<0.05)。结论 HT发生的高危因素包括有脑栓塞、大面积脑梗死等,临床应给予关注,采取积极手段展开治疗,改善预后。     

大面积脑梗死后出血性转化的危险因素分析

目的探讨大面积脑梗死患者急性期发生出血性转化的相关危险因素。方法回顾性分析102例大面积脑梗死患者的基本资料、治疗方法、生化指标等。按是否发生出血性转化分为出血性转化(HT)组25例和非出血性转化(NHT)组77例。对可能与HT相关的因素进行回归分析。结果 HT的发生率为24.51%;HT组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、纤维蛋白原低于NHT组,差异有统计学意义;HT组脂蛋白a(LPa)高于NHT组,差异有统计学意义。Logistic回归分析显示,TC(OR 2.350,95%CI 1.333～4.143)、LDL-C(OR 2.361,95%CI 1.347～4.138)、LPa(OR 0.965,95%CI 0.947～0.983)、纤维蛋白原(OR 2.397,95%CI 1.133～5.071)是发生出血性转化的独立危险因素(P<0.05)。结论 TC、LDL-C、LPa纤维蛋白原是大面积脑梗死发生出血性转化的独立危险因素。     

脑梗死出血转化相关危险因素分析及转归

目的 探讨脑梗死出血转化(hemorrhagic transformation,HT)的相关危险因素及出血与预后的关系.方法 回顾性分析432例脑梗死患者的临床资料.将10 d内复查头颅CT或MRI的患者160例,分为HT组80例,非HT组80例.列入多项危险因素进行单因素分析.卡方检验分析HT组和非HT组的结局,多因素回归分析出血转化的危险因素.结果 2组患者Logistic回归分析显示,差异有统计学意义的有3项因素:大面积脑梗死、溶栓治疗、入院时高血糖.结论 溶栓治疗、大面积脑梗死、入院时高血糖是HT的主要危险因素,HT组中发生脑实质血肿预后较差.     

血清Hcy、MMP-9对急性脑梗死患者溶栓后出血转化的预测价值

目的 探讨血清同型半胱氨酸(Hcy)、基质金属蛋白酶-9(MMP-9)对急性脑梗死(ACI)患者溶栓后出血转化(HT)的预测价值.方法 分析2019年1月至2021年1月宜宾市中医医院收治的118例ACI患者临床资料,根据是否发生HT分为HT组和非HT组.对比两组临床资料及血清Hcy、MMP-9水平差异,分析血清Hcy、MMP-9对ACI患者溶栓后发生HT的预测价值.结果 118例ACI患者经溶栓治疗后23例发生HT,发生率为19.49％.HT组患者梗死面积、NIHSS评分以及溶栓时间窗明显大于非HT组,血清Hcy、MMP-9水平也高于非HT组(P＜0.05).Logistic回归分析显示,梗死面积、NIHSS评分、溶栓时间窗、血Hcy和MMP-9水平是ACI溶栓后发生HT的危险因素(P＜0.05).血清Hcy+MMP-9联合检测的曲线下面积(AUC)为0.909,诊断灵敏度为91.3％,特异度为80.0％.结论 血清Hcy和MMP-9的表达与ACI患者溶栓后HT的发生密切相关,可作为预测HT的参考指标.     

胶质纤维酸性蛋白与非溶栓性出血性转化关系的研究

目的探讨脑梗死患者血浆胶质纤维酸性蛋白水平变化对非溶栓性出血性转化的预测作用。方法选择78例人院时间<72h且头部MRI检查无出血的急性脑梗死患者,发病7～10d后复查MRI,梯度回波序列显示低信号为出血性转化;酶联免疫吸附法定量检测血浆胶质纤维酸性蛋白水平;并探讨影响出血性转化的可能危险因素。结果 78例患者中11例梯度回波序列呈现低信号。脑梗死组患者血浆胶质纤维酸性蛋白水平[(2798.46±1072.66)ng/L]与正常对照组[(2173.37±867.77)ng/L]之间,差异有统计学意义(P=0.000);其中出血性转化组血浆胶质纤维酸性蛋白水平[(3660.03±629.64)ng/L]明显高于非转化组[(2657.01±1066.89)ng/L]和正常对照组[(2173.37±867.77)ng/L;(P=0.000,P=0.005)]。多因素Logistic逐步回归分析显示,血浆胶质纤维酸性蛋白水平及房颤为出血性转化的危险因素(P=0.005,P=0.017)。结论急性脑梗死患者发病72h内血浆胶质纤维酸性蛋白水平高于2856.90 ng/L,对非溶栓性出血性转化的发生具有预测意义,可作为预测非溶栓性出血性转化的标志物之一。     

溶栓前A2b受体水平与脑缺血出血转化的关系研究

目的 探讨腺苷A2b受体在急性脑缺血溶栓治疗后发生出血转化(hemorrhagic transformation,HT)中的应用价值。方法 收集2015年1月-2017年3月就诊于本院的缺血性脑卒中患者83例,治疗后根据CT和MRI复查表现分为HT组和非HT组,比较2组患者外周血单个核细胞腺苷A2b受体mRNA的表达情况,分析其对脑缺血溶栓治疗后发生HT的预测价值,经logistic回归分析脑缺血溶栓治疗后发生HT的危险因素,比较HT组和非HT组治疗后不同腺苷A2b受体mRNA表达水平患者的NIHSS评分。结果(1)经溶栓治疗后CT和MRI检查显示发生HT者有36例,占43.4%;(2)HT组患者外周血单个核细胞腺苷A2b受体mRNA的表达水平(0.83±0.19)明显高于非HT组(0.49±0.21),利用ROC曲线分析腺苷A2b受体预测脑缺血患者经溶栓治疗后发生HT的预测值为0.63,此时AUC=0.716, 95%CI=0.628～0.837,P<0.001;(3)经多因素非条件Logistic回归分析显示,腺苷A2b受体表达水平是脑缺血患者经溶栓治疗后发生HT的独立危险因素(OR=0.916, 95%CI=0.899～0.969,P=0.032);(4)经溶栓治疗后HT组中腺苷A2b受体>0.63的NIHSS评分最高,而非HT组腺苷A2b受体<0.63的NIHSS评分最低。结论 腺苷A2b受体表达水平是脑缺血患者经溶栓治疗后发生HT的独立危险因素,对患者经溶栓治疗后发生HT具有预测价值。     

脑梗死静脉溶栓治疗后出血性转化临床分析

目的探讨急性脑梗死患者溶栓治疗后出血性转化(hemorrhagic transformation,HT)的危险因素以及继发HT患者的溶栓后并发症。方法回顾性分析62例经静脉溶栓治疗的急性脑梗死患者的临床资料,结合文献选择溶栓后继发HT的危险因素,包括年龄、性别、高血压、糖尿病、心功能不全史、脑卒中史、有无早期CT缺血改变、是否大面积脑梗死、是否心源性脑栓塞、发病至溶栓时间、溶栓药物、溶栓前NIHSS评分、溶栓前血糖水平、溶栓后3d内最低纤维蛋白原水平、血小板计数、肌酐水平等进行分析,对单因素分析法发现有统计学差异的危险因素进一步行Logistic回归分析。结果单因素分析发现,与无HT组相比,继发HT组年龄较大(P<0.01),溶栓前血糖水平(P<0.05)、溶栓后6h和12h的收缩压和舒张压较高(均P<0.05),大面积脑梗死发病至溶栓时间>3h、有早期CT缺血改变的患者比例高(均P<0.05)。Logistic多因素回归分析发现高龄(OR:1.129,P<0.05)、溶栓时间>3h(OR:2.592,P<0.05)、早期CT有缺血改变(OR:1.728,P<0.05)是继发HT的危险因素。继发HT组出现颅外出血并发症(52.2%vs 20.5%,χ2=6.637,P<0.05)、重度脑水肿(30.4%vs 5.1%,χ2=5.567,P<0.05)和脑疝形成(26.1%vs 2.6%,P<0.05)的比例更高。结论急性脑梗死患者静脉溶栓后HT的发生率高,高龄、发病至溶栓时间>3h和早期CT缺血改变是HT的危险因素。     

神经功能缺损评分与高血压脑出血老年患者心脏事件的关系

目的 探讨神经功能缺损评分(NIHSS评分)与高血压脑出血老年患者心脏事件的关系.方法 选取90例高血压脑出血老年患者为研究对象,根据住院期间是否发生心脏事件分为发生组26例与未发生组64例,比较2组患者临床特征的差异,同时分析NIHSS评分与心脏事件发生的相关性,并采用ROC曲线分析NIHSS评分对不良心脏事件发生的...     

ICU脑出血患者肺部感染的影响因素分析

目的探讨影响ICU脑出血患者肺部感染的因素。方法选择我院ICU 2015-07-2016-07收治的脑出血患者111例为研究对象,回顾性分析其治疗过程和临床资料,运用Logistic回归分析对脑出血患者肺部感染的危险因素进行多因素分析。结果通过气管切开方式开放气道或气管插管及使用呼吸机时间≥3d的患者出现肺部感染的风险明显上升(P0.05);合并昏迷及慢性阻塞性肺疾病、住院时间≥14d、既往吸烟史且年龄≥60岁患者发生肺部感染的比率上升(P0.05);Logistic多因素分析发现,肺部感染与气管切开或气管插管、运用呼吸机时间≥3d、昏迷、合并慢性阻塞性肺疾病、住院时间≥14d、有吸烟史及年龄≥60岁等因素有关。结论 ICU脑出血患者出现肺部感染的影响因素有很多,应该加强病情监测,采取有效措施预防肺部感染,降低病死率。     

Can we predict poor outcome at presentation in patients with lobar hemorrhage?

OBJECTIVE: Supratentorial lobar hemorrhage can be devastating. Outcome prediction at presentation is important in triage and management decisions as well as appropriate resource utilization. We performed a decision tree analysis combining clinical and CT scan features to predict poor and hopeless outcome at initial presentation in patients with lobar hemorrhage. METHODS: We analyzed 81 patients with spontaneous lobar hemorrhage presenting within 48 hours of initial neurologic symptoms. In the first analysis, poor outcome was defined as Glasgow outcome score (GOS) of 1 (death), 2 (vegetative state) or 3 (dependence) at discharge. A second analysis was based on worst possible outcome (GOS 1-2). Binary recursive partitioning was fitted in a model, and odds ratios with 95% confidence intervals (CI) were calculated. RESULTS: Lobes involved were temporal (36%), parietal (33%), frontal (25%) and occipital (6%). Seventy-three percent of patients presented less than 17 h after initial ictus. The probability of poor outcome was 97% (CI 85-100%) in patients with hemorrhage greater than 40 cm(3). In the subset of patients with a volume less than 40 cm(3), time interval from ictus to presentation (< 17 h) together with a Glasgow coma score (GCS) less than or equal to 13 predicted poor outcome. Eighty-five percent (CI 42-99%) of those presenting early with GCS less than or equal to 13 had a poor outcome. In the second analysis, all patients with GCS less than or equal to 12 and septum pellucidum shift > 6 mm had GOS of 1 or 2 (CI 72-100%). CONCLUSION: Poor outcome in patients with lobar hemorrhage is associated with a hemorrhage size of more than 40 cm(3), GCS less than or equal to 13, but also dependent on time interval between ictus and presentation. This is consistent with prior studies demonstrating deterioration from enlargement may occur when patients present early on. Stupor and septum pellucidum shift greater than 6 mm on CT scan at presentation predict a hopeless outcome in conservatively treated patients. Ninety-one percent of patients were treated medically, thus these outcomes are largely a reflection of the natural history of spontaneous lobar hemorrhage. These signs may influence triage and management decisions.     

Hypertension, lipoprotein(a), and apolipoprotein A-I as risk factors for stroke in the Chinese.

We analyzed the serum concentrations of lipids and lipoproteins and the prevalence of other risk factors in a case-control study of 304 consecutive Chinese patients with acute stroke (classified as cerebral infarction, lacunar infarction, or intracerebral hemorrhage) and 304 age- and sex-matched controls. For all strokes we identified the following risk factors: a history of ischemic heart disease, diabetes mellitus, or hypertension; the presence of atrial fibrillation or left ventricular hypertrophy; a glycosylated hemoglobin A1 concentration of greater than 9.1%; a fasting plasma glucose concentration 3 months after stroke of greater than 6.0 mmol/l; a serum triglyceride concentration 3 months after stroke of greater than 2.1 mmol/l; and a serum lipoprotein(a) concentration of greater than 29.2 mg/dl. We found the following protective factors: a serum high density lipoprotein-cholesterol concentration of greater than 1.59 mmol/l and a serum apolipoprotein A-I concentration of greater than or equal to 106 mg/dl. The patterns of risk factors differed among the three stroke subtypes. When significant risk factors were entered into a multiple logistic regression model, we found a history of hypertension, a high serum lipoprotein(a) concentration, and a low apolipoprotein A-I concentration to be independent risk factors for all strokes. The attributable risk for hypertension was estimated to be 24% in patients aged greater than or equal to 60 years. In this population, in which cerebrovascular diseases are the third commonest cause of mortality, identification of risk factors will allow further studies in risk factor modification for the prevention of stroke.     

Risk Factors of Intracerebral Hemorrhage: A Case-Control Study

Background: Hypertension is a well-known risk factor for intracerebral hemorrhage (ICH). On many of the other potential risk factors, such as smoking, diabetes, and alcohol intake, results are conflicting. We assessed risk factors of ICH, taking also into account prior depression and fatigue. Methods: This is a population-based case-control study of 250 primary ICH patients, conducted in Helsinki University Hospital, Finland. The controls (n = 750) were participants of the FINRISK study, a large Finnish population survey on risk factors of chronic noncommunicable diseases, matched with cases by sex and age. Ages were matched in 5-year age bands. However, as the oldest FINRISK participants were 74-year-olds, controls for the age group 75-84 were selected from the age group of 70-74 years. Patients aged greater than or equal to 85 years were excluded. Patients and controls were compared in univariate analyses. The age categories less than 70, and greater than or equal to 70 years were also analyzed separately. Binary logistic regression analysis was performed for variables with P less than .1 in univariate analysis. Results: Analyzing all cases and controls, the cases had more hypertension, history of heart attack, lipid-lowering medication, and reported more frequently fatigue prior to ICH. In persons aged less than 70 years, hypertension and fatigue were more common among cases. In persons aged greater than or equal to 70 years, factors associated with risk of ICH were fatigue prior to ICH, use of lipid-lowering medication, and overweight. Conclusions: Hypertension was associated with risk of ICH among all patients and in the group of patients under 70 years. Fatigue prior to ICH was more common among all ICH cases.     

The Influence of Physical Activity on Cavernous Malformation Hemorrhage

Background and Aim: Cavernous malformations are low-flow vascular malformations of the central nervous system. Brainstem location and prior hemorrhage increase future hemorrhage risk. We sought to determine the influence of physical activity on hemorrhage risk. Methods: Consecutive patients with radiologically confirmed cavernous malformations participated in a prospective registry with structured, baseline interviews, surveys, and examinations. Patients were asked about unusual events prior to initial clinical presentation. Medical records and MRIs were reviewed. Patients were surveyed about their physical activity after receiving their diagnosis. Annual follow-up surveys to patients ascertained new hemorrhages. Follow-up terminated at last follow-up, hemorrhage, surgery, or death. Univariate analysis assessed the risk of physical activities on prospective hemorrhage. Results: Of 195 patients, 117 (60%) were female. Median diagnosis age was 41 years. After diagnosis, 103 (52.8%) patients returned the physical activity survey (cerebral n = 100; spine n = 3). Over 539.4 patient years, 23 had a prospective hemorrhage. Five patients were removed from analysis because they had less than 6 weeks of physical-activity exposure before censor. The remaining 98 had no difference in prospective hemorrhage risk than those patients participating greater than or equal to 3 times monthly in walking, running, greater than 20-pound or less than 20-pound weight lifting, or noncontact sports. Few (n = 5) reported contact-sport participation, scuba diving (n = 2), or high-altitude climbing (n = 1) greater than 3 times monthly. Conclusions: Aerobic activity and noncontact sports do not increase hemorrhage risk in cerebral cavernous malformation; patients should not be restricted. Less is known about contact sports, high-altitude climbing, scuba diving, and those with spinal-cord cavernous malformation.     

成人出血型脑底异常血管网症短期预后不良的危险因素分析

目的 探讨成人出血型脑底异常血管网症（MMD）短期预后不良的危险因素。方法 回顾性分析2018年1月至2020年1月收治的122例出血型MMD的临床资料。根据出院时改良Rankin量表评分评估短期预后,0~2分为预后良好,≥3分为预后不良。采用多因素logistic回归分析短期预后不良的危险因素。结果 出院时,122例中,预后不良66例,预后良好56例。多因素logistic回归分析结果显示,入院GCS评分≤9分、脑积水、脑内出血、蛛网膜下腔出血及中线位移≥5 mm为出血性MMD短期预后不良的独立危险因素（P<0.05）。结论 对于出血型MMD,入院时GCS评分、脑积水、脑实质内出血、蛛网膜下腔出血及中线移位等是短期预后不良的评估指标。     

重型颅脑损伤标准去骨瓣减压术后30 d内死亡的危险因素分析

目的 探讨重型颅脑损伤标准去骨瓣减压术后30d内死亡的危险因素.方法 回顾性分析2016年9月至2019年9月采用标准去骨瓣减压术治疗的145例重型颅脑损伤的临床资料.采用多因素logistic回归分析检验术后30 d内死亡的危险因素.结果 145例中,术后30 d内死亡43例,存活102例.多因素logistic回归...     

高龄急性脑梗死患者阿替普酶静脉溶栓有效性、安全性及预后影响因素分析

目的 探讨高龄急性脑梗死患者接受阿替普酶静脉溶栓治疗有效性、安全性和临床预后的影响 因素。 方法 前瞻性连续纳入江苏省苏北人民医院2016年9月-2018年9月收治入院进行阿替普酶静脉溶 栓治疗的急性脑梗死患者,按照年龄将患者分为年龄≥80岁组和年龄＜80岁组。比较两组患者入院 时、溶栓24 h NIHSS评分,6个月mRS评分及死亡率,观察两组溶栓相关出血转化、症状性颅内出血及 肺部感染的发生情况。应用多因素Logistic回归分析观察所有患者静脉溶栓预后的独立影响因素。 结果 最终共纳入患者119例,男性69例（58.0%）,年龄范围46～94岁,平均70.12±10.55岁,入院 NIHSS评分4～38分。其中年龄≥80岁患者29例,年龄＜80岁患者90例。静脉溶栓后,两组患者溶栓 24 h NIHSS评分较入院时均明显降低（均P＜0.05）,两组治疗24 h NIHSS评分比较差异无统计学意义; 两组的出血转化、症状性颅内出血、肺部感染、6个月预后良好及死亡率比较,差异均无统计学意义。 多因素Logistic回归分析显示,入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是脑梗死静脉溶 栓6个月预后的独立危险因素（P＜0.05）,高龄不是影响预后的因素（P＞0.05）。 结论 高龄急性脑梗死患者静脉溶栓治疗安全有效,未增加颅内出血转化风险、死亡率及不良预 后。入院到静脉溶栓时间、入院时NIHSS评分及肺部感染是急性脑梗死患者静脉溶栓6个月预后不良 的独立危险因素。     

急性脑梗死静脉溶栓患者出血转化及预后的危险因素研究

目的 探讨急性缺血性脑卒中(acute ischemic stroke,AIS)静脉溶栓后出血转化及预后的危险因素.方法 选择2017年6月-2019年6月211例进行静脉溶栓治疗的AIS患者为研究对象,其中出血转化(hemorrhagic tromsformation,HT)的34例患者记为HT组,未出血转化的177...