脑卒中溶栓后出血性转化与临床预后研究

目的 阐明中国汉族人急性脑卒中溶栓后出血性转化与临床预后的关系.方法 采用二分类Logistic回归回顾性分析脑卒中溶栓队列出血性转化和预后关系.结果 共纳入102例患者,男性44例(43.1％),女性58例(56.9％)；年龄中位数73岁；溶栓无出血转化73例(74.5％),梗塞性出血12例(12.2％),脑实质性出血13例(13.3％).预后良好44例(43.6％),预后不良57例(56.4％).溶栓后ASPECT评分可预示出血性转化(OR 0.15)和预后不良(OR 0.20)；血肌钙蛋白水平同样预示出血转化(OR 27.42)和不良结局(OR 12.16).其他独立影响因素为脉搏数(OR 2.18)和NIHSS评分(OR 2.00),但出血转化本身与预后无相关性.结论 溶栓后低ASPECT评分、基线高血肌钙蛋白水平、高NIHSS评分和高脉搏计数可以预测溶栓后3个月不良预后,出血性转化可能与预后无关.

Hemorrhagic Transformations and Prognoses in Stroke Patients with Thrombolysis

Objective To clarify the relations of hemorrhagic transformations and functional outcomes in Chinese stroke patients with thrombolysis. Method A retrospective cohort study with logistic regression analyses was performed. Results A total of 102 patients were included. Forty-four （43.1%） were males and 58（56.9%） were females. The median of age was 73. No hemorrhagic transformation was observed in 73（74.5%） patients, while hemorrhagic infarction in 12（12.2%） and parenchymal hemorrhage in 13 （ 13.3% ）. Forty-four （43.1%） patients got favorable outcome and 57 （56.4%） with unfavorable one. Lower ASPECT scale after thrombolysis（OR=0.15 and 0.20） and higher baseline troponin level（OR= 27.42 and 12.16） independently correlated with hemorrhagic transformation and unfavorable outcomes, respectively. Other predictors of unfavorable outcome were high NIHSS scale （OR=2.00） and high pulse count （OR=2.18）. Conclusions Lower ASPECT scale after thrombolysis, higher serum troponin level, higher NIHSS scale and high pulse count might independently predict 90-day unfavorable outcome in Chinese patients with thrombolysis. Hemorrhagic transformation might not correlate with functional outcome.