中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (12): 1101-1104,1110.doi: 10.12007/j.issn.0258-4646.2017.12.010

• 论著 • 上一篇    下一篇

急性脑梗死患者重组组织型纤溶酶原激活剂静脉溶栓后出血性转化的危险因素分析

周秉博1,2, 王晓宏1, 杨军1   

  1. 1. 中国医科大学附属第一医院神经内科, 沈阳 110001;
    2. 抚顺市中心医院神经内科, 辽宁 抚顺 113006
  • 收稿日期:2017-02-27 出版日期:2017-12-30 发布日期:2017-12-08
  • 通讯作者: 王晓宏 E-mail:411926510@qq.com
  • 作者简介:周秉博(1977-),男,主治医师,硕士.

Analysis of Risk Factors of Hemorrhagic Transformation after Thrombolytic Therapy Using Recombinant Tissue Plasminogen Activator in Patients with Acute Ischemic Stroke

ZHOU Bingbo1,2, WANG Xiaohong1, YANG Jun1   

  1. 1. Department of Neurology, The First Hospital, China Medical University, Shenyang 110001, China;
    2. Department of Neurology, Central Hospital of Fushun City, Fushun 113006, China
  • Received:2017-02-27 Online:2017-12-30 Published:2017-12-08

摘要: 目的 探讨急性脑梗死患者静脉输注重组组织型纤溶酶原激活剂(rt-PA)后出血性转化的相关危险因素。方法 采用病例-对照研究的方法,选取21例急性脑梗死接受rt-PA静脉溶栓治疗后出现脑出血性转化者为病例组,并选择同一时期63例急性脑梗死接受rt-PA静脉溶栓治疗后未发生脑出血性转化者为对照组。应用单因素及多因素logistic回归分析溶栓后出血性转化的相关危险因素。结果 单因素分析结果显示,病例组中溶栓前美国国立卫生院卒中量表(NIHSS)评分>10分、高血压(溶栓前收缩压≥ 140 mmHg)、溶栓前血糖值升高、具有心房颤动史和脑血管疾病史的比例显著高于对照组。多因素logistic回归分析结果显示,溶栓前收缩压≥ 140 mmHg(OR=14.59,95% CI:1.63~130.95)、溶栓前血糖值升高(OR=9.92,95% CI:0.97~101.24)以及具有脑血管疾病史(OR=10.75,95% CI:1.76~65.78)是急性脑梗死患者接受rt-PA静脉溶栓后出血性转化的危险因素。结论 溶栓前收缩压≥ 140 mmHg、溶栓前血糖值升高以及具有脑血管疾病史是急性脑梗死患者接受rt-PA静脉溶栓后出血性转化的危险因素。

关键词: 脑梗死, 静脉溶栓, 出血转化, 危险因素

Abstract: Objective To investigate the risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) in patients diagnosed with acute ischemic stroke. Methods The design for this research was a case-control study-21 patients with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA were categorized as cases,and 63 patients without hemorrhagic transformation after administration of thrombolytic therapy using rt-PA were categorized as controls. Univariate and multivariate logistic regression analysis were performed to analyze the risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA in patients diagnosed with acute ischemic stroke. Results Results of univariate analysis showed that positive baseline National Institutes of Health Stroke Scale (NIHSS) scores > 10,hypertension,baseline systolic blood pressure (SBP) ≥ 140 mmHg,increased blood glucose level,history of atrial fibrillation,and cerebrovascular disease (CVD) were significantly higher in the case group than in the control group. Results of multivariate logistic regression analysis showed that baseline SBP ≥ 140 mmHg (OR=14.59,95% CI:1.63-130.95),increased blood glucose level (OR=9.92,95% CI:0.97-101.24),and history of CVD (OR=10.75,95% CI:1.76-65.78) were independent risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA in patients diagnosed with acute ischemic stroke. Conclusion Baseline SBP ≥ 140 mmHg,increased blood glucose level,and history of CVD were observed to be independent risk factors associated with hemorrhagic transformation after administration of thrombolytic therapy using rt-PA in patients diagnosed with acute ischemic stroke.

Key words: ischemic stroke, thrombolytic therapy, hemorrhagic transformation, risk factor

中图分类号: 

  • R743.3
[1] CHAO AC,HSU HY,CHUNG CP,et al. Outcomes of thrombolytic therapy for acute ischemic stroke in chinese patients:the taiwan thrombolytic therapy for acute ischemic stroke (TTT-AIS) study[J]. Stroke,2010,41(5):885-890. DOI:10.1161/STROKEAHA.109.575605.
[2] GODSTEIN LB,ADAMS R,ALBERTS MJ,et al. Primary prevention of ischemic stroke:a guideline from the American heart association/American stroke association stroke council:cosponsored by the atherosclerotic peripheral vascular disease interdisciplinary working group;cardiovascular nursing council;clinical cardiology council;nutrition,physical activity,and metabolism council;and the quality of care and outcomes research interdisciplinary working group:the american academy of neurology affirms the value of this guideline[J]. Stroke,2006,37(6):1583-1633. DOI:10.1161/01.STR.0000223048.70103.F1.
[3] JAUCH EC,SAVER JL,ADAMS HP JR,et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the american heart association/american stroke association[J]. Stroke,2013,44(3):870-947. DOI:10.1161/STR.0b013e318284056a.
[4] HO BL,CHEN CF,LIN RT,et al. Clinical implication of hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator[J]. Neurol Sci,2016,37(11):1799-1805. DOI:10.1007/s10072-016-2667-x.
[5] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[J]. 中华神经科杂志,2010,43(2):146-153.
[6] 李刚,鲍欢,郝俊杰,等. 急性缺血性卒中患者的早期诊疗指南-美国心脏协会/美国卒中协会为医疗保健专业人员制定的指南(第六部分)[J]. 中国卒中杂志,2013,8(10):815-838.
[7] 重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组. 重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版)[J]. 中华内科杂志,2012,51(12):1006-1010.
[8] NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE rt-PA STROKE STUDY GROUP. Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med,1995,333(24):1581-1587. DOI:10.1056/NEJM199512143332401.
[9] SHOBHA N,BUCHAN AM,HILL MD,et al. Thrombolysis at 3-4.5 hours after acute ischemic stroke onset——evidence from the canadian alteplase for stroke effectiveness study (CASES) registry[J]. Cerebrovasc Dis,2011,31(3):223-228. DOI:10.1159/000321893.
[10] SUGIURA S,IWAISAKO K,TOYOTA S,et al. Simultaneous treatment with intravenous recombinant tissue plasminogen activator and endovascular therapy for acute ischemic stroke within 3 hours of onset[J]. Am J Neuroradiol,2008,29(6):1061-1066. DOI:10.3174/ajnr.A1012.
[11] 冯跃明,杨辉. 急性缺血性脑卒中患者静脉溶栓后不同部位出血转化的影响因素[J].中国实用神经疾病杂志,2016,19(3):59-61.
[12] MOKIN M,KASS-HOUT T,KASS-HOUT O,et al. Blood pressure management and evolution of thrombolysis-associated intracerebral hemorrhage in acute ischemic stroke[J]. J Stroke Cerebrovasc Dis,2012,21(8):852-859. DOI:10.1016/j.jstrokecerebrovasdis.2011.05.006.
[13] WAHLGREN N,ANMED N,ERIKSSON N,et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials:safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST)[J]. Stroke,2008,39(12):3316-3322. DOI:10.1161/STROKEAHA.107.510768.
[14] ALDERAZI YJ,CHANG J,YANG JP,et al. Impact of protocol deviations in acute ischemic stroke treated with intravenous rt-PA within 4.5 hours after symptom onset[J]. Neurohospitalist,2012,2(3):82-86. DOI:10.1177/1941874412441802.
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