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急性缺血性卒中的出血性转化和转归:回顾性病例系列研究

被引：5
作者：
万琛宜
黄经纬
洪道俊
万慧
吴裕臣
徐文苑
机构：
[1] 南昌大学第一附属医院神经内科
来源：
国际脑血管病杂志 | 2013年 / 03期
关键词：
卒中; 脑缺血; 脑出血; 磁共振成像; 危险因素; 预后;
D O I：
暂无
中图分类号：
R743.3 [急性脑血管疾病（中风）];
学科分类号：
1002 ;
摘要：
目的探讨急性缺血性卒中的出血性转化（hemorrhagic transformation,HT）和转归。方法回顾性收集急性缺血性卒中患者的人口统计学、血管危险因素、影像学和其他临床资料并进行比较;利用磁敏感加权成像（susceptibility weighted irnagmg SWI）诊断HT,并将患者分为HT组和非HT组;应用改良Rankin量表评价临床转归。采用多变量logistic回归分析确定HT以及HT患者转归不良的独立危险因素。结果共纳入96例急性缺血性卒中患者,其中34例出现HT（35.4%）。HT组年龄[（66.21±7.04）岁对（61.21±13.42）岁;t=2.020,P=0.046]和梗死体积[（3.88±2.20）cm3对（1.96±1.37）cm3;t=5.267,P=0.001]显著性大于非HT组,高血压（58.8%对30.6%χ2=7.228,P=0.007）、糖尿病（29.4%对6.5%;χ2=9.293,P=0.002）、心房颤动（35.3%对3.2%;χ2=18.128,P=0.000）、心源性脑栓塞（35.3%对3.2%;P=0.000）患者的构成比显著性高于非HT组,而小动脉闭塞性卒中患者的构成比显著性低于非HT组（38.2%对62.9%;P=0.032）。多变量logistic回归分析显示,年龄[优势比（odds ratio,OR）1.168,95%可信区间（confidence interval,CI）1.059～3.412;P=0.021]、梗死体积（OR 3.461,95%CI 1.317～6.270;P=0.044）和心房颤动（OR 1.284,95%CI1.1 17～2.903;P=0.015）为HT的独立危险因素。在HT患者中,转归不良组年龄[（69.46±7.17）岁对（64.19±6.31）岁;t=2.248,P=0.032]显著性大于转归良好组,高血压（84.6%对42.9%;χ2=5.781,P=0.016）、糖尿病（50.0%对14.3%;χ2=6.053,P=0.014）、心源性脑栓塞（61.5%对19.0%;P=0.025）和血肿型HT（76.9%对19.0%;χ2=11.104,P=0.001）的构成比显著性高于转归良好组。多变量logistic回归分析显示,糖尿病（OR 2.151,95%CI 1.179～3.218;P=0.023）、心房颤动（OR 4.136,95%CI1.010～8.413;P=0.046）和血肿型HT（OR 2.134,95%CI 1.219～4.452;P=0.039）为HT患者发病3个月时转归不良的独立危险因素。结论急性缺血性卒中患者HT发生率为35.4%,年龄、梗死体积和心房颤动为HT的独立危险因素,而糖尿病、心房颤动和血肿型HT为HT患者发病3个月时转归不良的独立危险因素。
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页码：161 / 165
相关论文
共 78 条
[1]  
Two tales: hemorrhagic transformation but not parenchymal hemorrhage after thrombolysis is related to severity and duration of ischemia: MRI study of acute stroke patients treated with intravenous tissue plasminogen activator within 6 hours. G. Thomalla,J. Sobesky,M. Kohrmann. Stroke . 2007
[2]  
Two tales: hemorrhagic transformation but not parenchymal hemorrhage after thrombolysis is related to severity and duration of ischemia: MRI study of acute stroke patients treated with intravenous tissue plasminogen activator within 6 hours. G. Thomalla,J. Sobesky,M. Kohrmann. Stroke . 2007
[3]  
Hemorrhagic transformation in acute ischemic stroke. Jaillard A,Cornu C,Durieux A,et al. Stroke . 1999
[4]  
Hemorrhagic transformation in acute ischemic stroke. Jaillard A,Cornu C,Durieux A,et al. Stroke . 1999
[5]  
Susceptibility Weighted Imaging: Neuropsychologic Outcome and Pediatric Head Injury[J] . Talin Babikian,M. Catherin Freier,Karen A. Tong,Joshua P. Nickerson,Christopher J. Wall,Barbara A. Holshouser,Todd Burley,Matt L. Riggs,Stephen Ashwal. &nbspPediatric Neurology . 2005 (3)
[6]  
Susceptibility Weighted Imaging: Neuropsychologic Outcome and Pediatric Head Injury[J] . Talin Babikian,M. Catherin Freier,Karen A. Tong,Joshua P. Nickerson,Christopher J. Wall,Barbara A. Holshouser,Todd Burley,Matt L. Riggs,Stephen Ashwal. &nbspPediatric Neurology . 2005 (3)
[7]  
Diffuse axonal injury in children: Clinical correlation with hemorrhagic lesions[J] . Karen A.Tong,StephenAshwal,Barbara A.Holshouser,Joshua P.Nickerson,Christopher J.Wall,Lori A.Shutter,Renatta J.Osterdock,E. M.Haacke,DanielKido. &nbspAnn Neurol. . 2004 (1)
[8]  
Diffuse axonal injury in children: Clinical correlation with hemorrhagic lesions[J] . Karen A.Tong,StephenAshwal,Barbara A.Holshouser,Joshua P.Nickerson,Christopher J.Wall,Lori A.Shutter,Renatta J.Osterdock,E. M.Haacke,DanielKido. &nbspAnn Neurol. . 2004 (1)
[9]  
Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials[J] . &nbspThe Lancet . 2004 (9411)
[10]  
Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials[J] . &nbspThe Lancet . 2004 (9411)
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