《中国康复理论与实践》

《中国康复理论与实践》

• 临床研究 • 上一篇    下一篇

心源性脑栓塞出血转化的危险因素及其与预后的关系①

吴章薇，赵军，李冰洁，梅利平，郭鸣，周昊   

  1. 1.首都医科大学康复医学院，北京市100068；2.中国康复研究中心北京博爱医院神经内科，北京市100068。
  • 出版日期:2016-05-25 发布日期:2016-07-04

Risk Factors and Outcome of Hemorrhagic Transformation of Cardiogenic Cerebral Embolism

WU Zhang-wei, ZHAO Jun, LI Bing-jie, MEI Li-ping, GUO Ming, ZHOU Hao   

  1. 1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China; 2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
  • Published:2016-05-25 Online:2016-07-04

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摘要： 目的探讨心源性脑栓塞出血转化(HT)的临床危险因素及其对预后的影响。方法回顾性分析2012 年5 月~2015 年12月住院的115 例心房颤动并发脑栓塞患者的临床资料。根据有无颅内出血分为HT组(n=58)与非HT组(n=57)。对两组年龄、脑栓塞前后抗栓治疗、溶栓、梗死灶大小、糖尿病、冠心病、高脂血症、美国国立卫生研究院脑卒中评分(NIHSS)及HAS-BLED评分进行单因素和多因素Logistic 回归分析。比较两组发病时、发病后1 个月、发病后3 个月NIHSS 和改良Rankin 量表(mRS)评分。结果单因素分析显示，两组间NIHSS 评分(t=-2.991, P=0.003)、HAS-BLED 评分(t=-2.499, P=0.014)、梗死灶大小(χ2=8.355, P=0.004)有显著性差异。多因素Logistic 回归显示，NIHSS(OR=1.127, P=0.027)、梗死灶大小(OR=4.390, P=0.035)和HAS-BLED评分(OR=1.783, P=0.03)均是HT的独立危险因素。按HAS-BLED评分分组，低危组(0~2 分)HT 发生率低于高危组(≥3 分) (χ2=4.643, P=0.031)。发病时、发病后1 个月、发病后3 个月，HT组NIHSS评分均高于非HT组(t>2.387, P<0.05)；HT组发病时mRS评分高于非HT组(t=-2.262, P=0.026)；发病后1 个月和3 个月，两组mRS评分均无显著性差异(t<1.468, P>0.05)。结论心房颤动后脑栓塞患者，神经功能缺损较重、梗死灶较大、HAS-BLED评分较高的患者更易发生HT；HT组神经功能的恢复较非HT组差。

关键词: 脑栓塞, 心房颤动, 出血转化, 危险因素, 预后

Abstract: Objective To analyze the clinical risk factors of hemorrhagic transformation (HT) of cardiogenic cerebral embolism and the influence of HT on outcome. Methods The clinical data of 115 inpatients were reviewed from May, 2012 to December, 2015. They were divided into HT group (n=58) and non-HT group (n=57). The age, anticoagulant therapy, thrombolytic therapy, infarction diameter, diabetes, coronary heart disease, hyperlipidemia, the National Institutes of Health Stroke Scale (NIHSS) score and HAS-BLED score were compared.The risk factors for HT was screened with the multivariate Logistic regression. NIHSS score and Modified Rankin Scale (mRS) score as hospitalization, and one month and three months after stroke were compared. Results There were significant difference in NIHSS score (t=-2.991, P=0.003) and HAS-BLED score (t=-2.499, P=0.014), as well as infarction diameter (χ2=8.355, P=0.004) between HT group and non-HT group. NIHSS score (OR=1.127, P=0.027), HAS-BLED score (OR=1.783, P=0.03) and infarction diameter (OR=4.390, P=0.035) were the risk factors for HT. The incidence of HT was less in low-risk group (HAS-BLED score=0-2) than in high-risk group (HAS-BLED score≥3) (χ2=4.643, P=0.031). The NIHSS score as hospitalization, and one month and three months after stroke were all more in HT group than in non-HT group (t>2.387, P<0.05). The mRS score was more in HT group as hospitalization (t=-2.262, P=0.026), but not significant one and three months later (t<1.468, P>0.05). Conclusion HT tends to happen in the patients of cerebral embolism patients after atrial fibrillation with severe neural function defect, large infarction diameter and high HAS-BLED score. The neural function is poor in those with HT.

Key words: cerebral embolism, atrial fibrillation, hemorrhagic transformation, risk factor, outcome