脑梗死后出血转化的危险因素分析

目的探讨脑梗死患者出血转化（HT）的危险因素。方法回顾性分析2008年8月—2011年8月南京医科大学附属杭州市第一人民医院神经内科收治的960例脑梗死患者的临床资料。根据是否发生HT,将其分为HT组（90例）及非HT组（870例）。观察两组患者入院24 h内的血压、餐后及空腹血糖、胆固醇水平,影像学监测到的梗死面积,心房颤动,溶栓治疗,入院前、后的抗凝治疗,既往抗血小板聚集治疗史。对差异有统计学意义的指标采用多因素Logistic回归方法确定HT的危险因素,并对比类肝素药物治疗急性缺血性卒中试验（TOAST）分型中各类型脑梗死HT的发生率。结果①多因素Logistic回归结果显示,大面积脑梗死（P=0.000,OR=10.519,95%CI：6.600～16.766）、心房颤动（P=0.006,OR=1.913,95%CI：1.206～3.003）、溶栓治疗（P=0.033,OR=2.502,95%CI：1.078～5.805）、抗凝治疗（P=0.000,OR=7.877,95%CI：2.491～25.911）、餐后血糖≥10 mmol/L或空腹血糖≥7.0 mmol/L（P=0.011,OR=0.822,95%CI：1.146～2.897）是HT的独立危险因素;收缩压≥180 mm Hg和（或）舒张压≥110 mm Hg、高胆固醇（5.98 mmol/L）以及抗血小板聚集史不是HT的独立危险因素。②TOAST分型中,心源性栓塞型脑梗死患者的HT发生率最高（21.4%,34/159）,小动脉闭塞型脑梗死患者的HT发生率最低（1.1%,2/181）,大动脉粥样硬化型脑梗死HT的发生率为8.6%（51/593）。结论大面积脑梗死、心房颤动、溶栓、抗凝、高血糖等是HT的独立危险因素。心源性栓塞型脑梗死是发生HT的重要原因之一。

Analysis of risk factors for hemorrhagic transformation after cerebral infarction

Objective To investigate the risk factors for hemorrhagic transformation(HT) in patients with cerebral infarction.Methods The clinical data of 960 patients with cerebral infarction admitted to the Department of Neurology,Hangzhou First People’s Hospital Affiliated to Nanjing Medical University were analyzed retrospectively.They were divided into HT group(n=90) and non-HT group(n=870) according to whether they had HT or not.The blood pressure,postprandial and fasting blood glucose,cholesterol levels,infarct size detected by imaging,atrial fibrillation and thrombolysis within 24 hours of admission,anticoagulant therapy before or after admission,previous history of anti-platelet aggregation therapy and TOAST classification in both groups were observed.The risk factors for HT were identified by univariate chi-square test and multivariate logistic regression analysis,and the incidences of HT in various types of cerebral infarction in the TOAST classification were compared.Results ①The results of multivariate logistic regression analysis showed that massive cerebral infarction(P=0.000,OR=10.519,95%CI 6.600-16.766),atrial fibrillation(P=0.006,OR=1.913,95%CI 1.206-3.003),thrombolysis(P=0.033,OR=2.502,95%CI 1.078-5.805),anticoagulation(P=0.000,OR=7.877,95%CI 2.491-25.911),and postprandial glucose ≥10 mmol/L or fasting glucose ≥7.0 mmol/L(P=0.011,OR=0.822,95%CI 1.146-2.897) were the independent risk factors for HT.Systolic blood pressure ≥ 180 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg,high cholesterol(≥ 5.98 mmol/L),and the history of anti-platelet aggregation were not the independent risk factors for HT.②In the TOAST classification,the HT incidence in patients with cardioembolic cerebral infarction was the highest(21.4%,34/159),the HT incidence of small artery occlusion was lower(1.1%,2/181),and the HT incidence of large artery atherosclerosis was 8.6%(51/593).Conclusion Massive cerebral infarction,atrial fibrillation,thrombolysis,anticoagulation,postprandial glucose ≥ 10 mmol/L or fasting glucose ≥ 7.0 mmol/L are the independent risk factors for HT.Cardioembolic cerebral infarction is one of the major reasons for the occurrence of HT.