脑梗死出血性转化相关危险因素的分析

目的探讨脑梗死出血性转化（hemorrhagic transformation,HT）的相关危险因素。方法回顾性分析361例前循环脑梗死患者的临床和神经影像学资料。从中选出性别、年龄相匹配,发病15d内复查头部CT或MRI的患者120例,分为HT组60例,非HT组60例。列入20项影响因素进行单因素分析,包括高血压病史、大面积脑梗死、尿蛋白阳性、高胆固醇血症及心房颤动史等。对以上因素行χ2或t检验,将可能与HT有关的因素采用Logistic回归分析,以筛选出与HT相关的危险因素。结果两组患者Logistic回归分析显示,差异有统计学意义的有4项因素,根据OR值的大小依次排列为：脑梗死面积（OR=10.489,95%CI：3.647~30.167,P=0.001）、尿蛋白阳性（OR=5.332,95%CI：1.397~20.345,P=0.014）、高胆固醇血症（OR=5.252,95%CI：1.308~21.083,P=0.019）及心房颤动史（OR=4.500,95%CI：1.029~19.684,P=0.046）。结论大面积脑梗死、尿蛋白阳性、高胆固醇血症及心房颤动史是HT的主要危险因素。同时HT的发生是多因素、多机制共同作用的结果。

Related risk factors of hemorrhagic transformation after cerebral infarction: a clinical analysis

Objective To investigate the related risk factors of hemorrhagic transformation(HT)after cerebral infarction.Methods The clinical and neuroimaging data were analyzed retrospectively in 361 patients with anterior circulation infarction.Head CT or MRI of 120 cases was repeated within 15 days after the onset.These patient who had HT were defined as patient group(HT group),and the patients who did not have HT were defined as control group(NHT group),each group had 60 patients.Twenty influencing factors were listed for single factor analysis including history of hypertension,massive cerebral infarction,positive urinary protein,hypercholesterolemia,and previous atrial fibrillation,etc.All the above factors were analyzed by chi-square test or t test,and logistic regression analysis was used for the potentially related factors with HT to screen out the related risk factors with HT.Results The logistic regression analysis showed that there were significant differences in 4 factors between the 2 groups.According to the orders of OR values they were:cerebral infarction volume(OR=10.489,95%CI:3.647~30.167,P=0.001),positive proteinuria(OR=5.332,95%CI:1.397-20.345,P=0.014),hypercholesteremia(OR=5.252,95%CI:1.308-21.083,P=0.019),and atrial fibrillation(OR=4.500,95% CI:1.029-19.684,P=0.046).Conclusions The massive cerebral infarction,positive urinary protein,hypercholesterolemia,and previous atrial fibrillation are the major risk factors of HT.At the same time,the occurrence of HT is the result of the joint effort of multiple factors and multiple mechanisms.