中华脑科疾病与康复杂志(电子版) 2016年6月,6卷3期

临床研究

脑梗死出血性转化的危险因素分析

高俊杰 许雯蔚 陈湛愔 何国林

524037 广东省,湛江中心人民医院神经内科
陈湛愔,Email:chenzhanyin@126.com

摘要:目的 探讨脑梗死后出血性转化的危险因素。方法 选择湛江中心人民医院2008年1月至2015年12月住院的急性出血性脑梗死患者233例作为研究对象。其中,自发性出血性转化145例,动静脉溶栓[应用尿激酶(100~150)万U静脉注射]后出血性转化52例,抗凝和抗血小板治疗后出血性转化36例。对影响因素如神经功能缺损评分、脑梗死体积、糖尿病病程、高血压病程、糖化血红蛋浓度、皮质下脑白质病变、低密度脂蛋白(LDL)、颈动脉狭窄程度、颈动脉内膜-中层厚度、颈动脉斑块大小、高尿酸血症分别采用线性回归和逐步回归进行分析,探索其对出血性转化的影响。结果 自发性脑梗死后出血性转化、脑梗死溶栓后出血性转化及抗血小板治疗后的出血性转化,均与神经功能缺损评分、脑梗死体积、糖尿病病程、高血压病程、糖化血红蛋白浓度、皮质下脑白质病变、LDL、颈动脉狭窄程度、颈动脉内膜-中层厚度、颈动脉斑块大小、高尿酸血症呈正相关(均P<0.05)。回归分析显示,影响脑梗死后出血性转化的主要危险因素是神经功能缺损评分、脑梗死体积、糖尿病和高血压病程及伴心房颤动、糖化血红蛋白、LDL和血尿酸、皮质下脑白质病变、颈动脉狭窄、颈动脉内膜-中层厚度、斑块大小等(均P<0.05)。结论 急性脑梗死后实施溶栓、抗栓、抗血小板等干预措施时应密切关注相关高危因素。

关键词:脑梗死; 危险因素; 出血性转化; 溶栓; 抗栓抗血小板

广东省科技厅科学技术研究基金立项资助课题(A2009271)

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(编辑:杨智华 收稿日期:2016-04-22)