经阿替普酶静脉溶栓治疗的急性缺血性脑卒中合并心房颤动患者出血转化及预后的影响因素研究

背景出血转化是溶栓治疗的主要并发症,其会加重患者神经功能缺损程度甚至导致患者死亡,因此提前预测患者出血转化风险对临床治疗具有重要意义。目的分析经阿替普酶静脉溶栓治疗的急性缺血性脑卒中(AIS)合并心房颤动患者出血转化及预后的影响因素。方法选取2017—2019年郴州市第四人民医院神经内科收治的AIS合并心房颤动患者60例为研究对象,所有患者入院后接受阿替普酶静脉溶栓治疗。根据溶栓治疗后24 h有无出血转化将所有患者分为出血转化组27例和无出血转化组33例,根据溶栓治疗后3个月预后将所有患者分为预后良好组改良Rankin量表(m RS)评分≤2分]39例和预后不良组(m RS评分> 2分)21例。收集所有患者出血转化和预后的可能影响因素,并采用多因素Logistic回归分析探讨经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者出血转化及预后的影响因素。结果多因素Logistic回归分析结果显示,溶栓治疗后24 h收缩压> 140 mm Hg OR=2.356,95%CI(1.337,4.151)]、基线空腹血糖> 5.6 mmol/LOR=3.525,95%CI(2.190,5.676)]、发病至溶栓治疗时间> 3 hOR=4.773,95%CI(1.586,14.361)]、基线美国国立卫生研究院卒中量表(NIHSS)评分> 7分OR=4.609,95%CI(2.258,9.407)]、溶栓治疗后2 h NIHSS评分> 7分OR=1.241,95%CI(1.047,1.472)]是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者发生出血转化的独立危险因素(P <0.05);基线空腹血糖> 5.6 mmol/LOR=2.394,95%CI(1.666,3.440)]、溶栓治疗后2 h NIHSS评分> 7分OR=2.620,95%CI(1.173,5.851)]是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者预后不良的独立危险因素(P <0.05)。结论溶栓治疗后24 h收缩压> 140 mm Hg、基线空腹血糖> 5.6 mmol/L、发病至溶栓治疗时间> 3 h、基线及溶栓治疗后2 h NIHSS评分> 7分是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者发生出血转化的危险因素,基线空腹血糖> 5.6 mmol/L和溶栓治疗后2 h NIHSS评分> 7分是经阿替普酶静脉溶栓治疗的AIS合并心房颤动患者预后不良的危险因素,应引起临床医生重视。

Influencing Factors of Hemorrhage Transformation and Prognosis in Patients with Acute Ischemic Stroke Complicated with Atrial Fibrillation Treated by Intravenous Thrombolysis with Alteplase

Background Hemorrhage transformation(HT)is the main complication of thrombolytic therapy,which can aggravate the degree of neurological deficit and even lead to death.Therefore,it is important to predict the risk of HT in advance for clinical treatment.Objective To analyze the influencing factors on HT and prognosis in patients with acute ischemic stroke(AIS)complicated with atrial fibrillation treated by intravenous thrombolysis with alteplase.Methods A total of 60 patients with AIS complicated with atrial fibrillation admitted to the Fourth People’s Hospital of Chenzhou from 2017 to 2019 were selected as the research objects.All patients received intravenous thrombolysis with alteplase after admission.The patients were divided into the HT group(n=27)and non-HT group(n=3)according to whether occured HT 24 h after thrombolytic therapy.The patients were divided into the good prognosis groupmodified Rankin Scale(mRS)score≤2,n=39]and the poor prognosis group(mRS score>2,n=21)according to the mRS score 3 months after thrombolytic therapy.The possible influencing factors on HT and prognosis were collected,and the multivariate Logistic regression was used to analyze the influencing factors on HT and prognosis in patients with AIS complicated with atrial fibrillation treated by intravenous thrombolysis with alteplase.Results Multivariate Logistic regression analysis showed that systolic blood pressure>140 mm Hg at 24 h after thrombolytic therapyOR=2.356,95%CI(1.337,4.151)],baseline fasting blood glucose>5.6 mmol/LOR=3.525,95%CI(2.190,5.676)],time from onset to thrombolytic therapy>3 hOR=4.773,95%CI(1.586,14.361)],baseline National Institutes of Health Stroke Scale(NIHSS)score>7OR=4.609,95%CI(2.258,9.407)],and NIHSS score>7 at 2 h after thrombolytic therapyOR=1.241,95%CI(1.047,1.472)]were independent risk factors of HT in AIS patients with atrial fibrillation treated by intravenous thrombolysis with alteplase(P<0.05).Baseline blood glucose>5.6 mmol/LOR=2.394,95%CI(1.666,3.440)]and NIHSS score>7 at 2 h after thrombolytic therapyOR=2.620,95%CI(1.173,5.851)]were independent risk factors of poor prognosis in AIS patients complicated with atrial fibrillation treated with intravenous thrombolytic therapy(P<0.05).Conclusion Systolic blood pressuree>140 mm Hg at 24 h after thrombolytic therapy,baseline fasting blood glucose>5.6 mmol/L,time from onset to thrombolytic therapy>3 h,baseline NIHSS score>7 and NIHSS score>7 at 2 h after thrombolytic therapy are risk factors for HT in patients with AIS complicated with atrial fibrillation treated by intravenous thrombolysis with alteplase,and baseline fasting blood glucose>5.6 mmol/L and baseline NIHSS score>7 are risk factors for poor prognosis in patients with AIS complicated with atrial fibrillation treated by intravenous thrombolysis with alteplase,and the clinical doctors should pay enough attention to them.