老年腔隙性脑梗死患者溶栓治疗后出血性转化的发生情况及其影响因素研究

背景有研究表明,老年腔隙性脑梗死患者溶栓治疗后出血性转化的发生率高达80%。但目前人们对此现象的影响因素仍缺乏深入的认识,而如何加强防控也鲜少有系统化的报道。目的分析老年腔隙性脑梗死患者溶栓治疗后出血性转化的发生情况,并探讨其出血性转化的影响因素。方法回顾性分析2016年2月—2019年3月于淮南东方医院集团总院收治的经溶栓治疗的老年腔隙性脑梗死患者169例,根据溶栓治疗后发生出血性转化为发生组(n=33),未发生出血性转化为未发生组(n=136)。比较两组患者临床特征,老年腔隙性脑梗死患者溶栓治疗后出血性转化的影响因素采用多因素Logistic回归分析。结果出血性转化的发生率为19.5%(33/169)。发生组患者高血压发生率、心房颤动发生率及吸烟指数>400支年、饮酒史、抑郁症、尿蛋白阳性、超时间窗溶栓、大腔梗死者所占比例高于未发生组(P<0.05),两组患者入院美国国立卫生研究院卒中量表(NIHSS)评分、溶栓治疗后抗凝药物比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压〔OR=4.899,95%CI(2.349,10.216)〕、心房颤动〔OR=7.783,95%CI(3.617,16.749)〕、吸烟指数>400支年〔OR=3.823,95%CI(1.845,8.406)〕、饮酒史〔OR=5.966,95%CI(2.306,15.434)〕、抑郁症〔OR=5.317,95%CI(2.067,13.677)〕、尿蛋白阳性〔OR=6.659,95%CI(2.436,18.201)〕、入院NIHSS评分>14分〔OR=7.576,95%CI(2.671,21.493)〕、超时间窗溶栓〔OR=6.767,95%CI(2.294,19.964)〕、大腔梗死〔OR=7.493,95%CI(2.015,22.325)〕、华法林〔OR=4.670,95%CI(1.815,13.482)〕、其他抗凝药物〔OR=5.703,95%CI(2.085,15.315)〕是老年腔隙性脑梗死患者溶栓治疗后出血性转化的危险因素(P<0.05)。结论老年腔隙性脑梗死溶栓治疗后存在高出血性转化发生风险,多发生于溶栓治疗后1周内,且高血压、心房颤动、吸烟指数>400支年、饮酒史、抑郁症、尿蛋白阳性、入院NIHSS评分>14分、超时间窗溶栓、大腔梗死、华法林、其他抗凝药物是老年腔隙性脑梗死患者溶栓治疗后出血性转化的危险因素。

Occurrence of Hemorrhagic Transformation in Elderly Patients with Lacunar Infarction after Thrombolytic Therapy and Its Influencing Factors

Background Studies have shown that the incidence of hemorrhagic transformation in the elderly patients with lacunar cerebral infarction after thrombolysis is as high as 80%.However,at present,people still lack indepth understanding of the influencing factors of this phenomenon,and there were few systematic reports on how to strengthen prevention and control.Objective To investigate the occurrence of hemorrhagic transformation in elderly patients with lacunar infarction after thrombolytic therapy and to explore its influencing factors.Methods A total of 169 elderly patients with lacunar infarction treated by thrombolysis were selected in General Hospital of Huainan Oriental Hospital Group from February 2016 to March 2019,thereinto divided to hemorrhagic transformation group(n=33)and no hemorrhagic transformation group(n=136)according to occurrence of hemorrhagic transformation after thrombolysis.Clinical characteristics between the two groups were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of hemorrhagic transformation in elderly patients with lacunar cerebral infarction after thrombolysis.Results The incidence of hemorrhagic transformation was 19.5%(33/169).The incidence of hypertension,atrial fibrillation,smoking index>400,drinking history,depression,urinary protein positive,thrombolysis beyond time window,and large lumen infarction in hemorrhagic transformation group were statistically significantly higher than those in no hemorrhagic transformation group(P<0.05).There were statistically significantly differences in NIHSS scores at admission and anticoagulants after thrombolysis between the two groups(P<0.05).Multivariate Logistic regression analysis result showed that,hypertension〔OR=4.899,95%CI(2.349,10.216)〕,atrial fibrillation〔OR=7.783,95%CI(3.617,16.749)〕,smoking index>400〔OR=3.823,95%CI(1.845,8.406)〕,drinking history〔OR=5.966,95%CI(2.306,15.434)〕,depression〔OR=5.317,95%CI(2.067,13.677)〕,urinary protein positive〔OR=6.659,95%CI(2.436,18.201)〕,NIHSS score>14 at admission〔OR=7.576,95%CI(2.671,21.493)〕,thrombolysis beyond time window〔OR=6.767,95%CI(2.294,19.964)〕,large lumen infarction〔OR=7.493,95%CI(2.015,22.325)〕,warfarin〔OR=4.670,95%CI(1.815,13.482)〕and other anticoagulants〔OR=5.703,95%CI(2.085,15.315)〕were the risk factors for hemorrhagic transformation in elderly patients with lacunar cerebral infarction after thrombolysis(P<0.05).Conclusion There is a high risk of hemorrhagic transformation after thrombolytic therapy for lacunar infarction in the elderly,mostly within 1 week after thrombolytic therapy.Hypertension,atrial fibrillation,smoking index>400,drinking history,depression,urinary protein positive,NIHSS score>14 at admission,thrombolysis beyond time window,lacunar lumen infarction,warfarin,and other anticoagulants using are the risk factors for hemorrhagic transformation in elderly patients with lacunar cerebral infarction after thrombolysis.