CAJ | 학술논문

目的探讨脑白质高信号(WMHs)严重程度与急性缺血性卒中患者静脉重组组织型纤溶酶原激活剂(rt-PA)溶栓后的出血转化以及3个月后神经功能结局之间的关系.方法回顾性分析接受静脉rt-PA溶栓治疗的急性缺血性卒中患者132例的临床资料,根据改良Schelten量表进行WMHs评分,出血转化包括出血性梗死(HI)型和脑实质出血(PH)型,改良Rankin评分2～6分定义为不利的神经功能结局.结果 132例溶栓治疗共26例(19.7％,26/132)发生出血转化.其中17例为HI型,9例为PH型.经多元Logistic回归分析结果显示,基线美国国立卫生研究院卒中量表(NIHSS)评分、舒张压及WMHs评分与HI型出血转化无关(P＞0.05);WMHs评分与PH型出血转化亦无相关性(P＜0.05),而基线NIHSS评分、舒张压是PH型出血转化的独立危险因素(P＜0.05).二元Logistic回归分析结果显示,WMHs评分是不利的神经功能结局独立危险因素(OR=1.136,95％CI 1.037～1.245,P=0.008).结论严重WMHs不增加急性缺血性卒中静脉rt-PA溶栓后的出血转化风险,但与卒中后不利的神经功能结局有关.
목적 탐토뇌백질고신호(WMHs)엄중정도여급성결혈성졸중환자정맥중조조직형섬용매원격활제(rt-PA)용전후적출혈전화이급3개월후신경공능결국지간적관계.방법 회고성분석접수정맥rt-PA용전치료적급성결혈성졸중환자132례적림상자료,근거개량Schelten량표진행WMHs평분,출혈전화포괄출혈성경사(HI)형화뇌실질출혈(PH)형,개량Rankin평분2～6분정의위불리적신경공능결국.결과 132례용전치료공26례(19.7％,26/132)발생출혈전화.기중17례위HI형,9례위PH형.경다원Logistic회귀분석결과현시,기선미국국립위생연구원졸중량표(NIHSS)평분、서장압급WMHs평분여HI형출혈전화무관(P＞0.05);WMHs평분여PH형출혈전화역무상관성(P＜0.05),이기선NIHSS평분、서장압시PH형출혈전화적독립위험인소(P＜0.05).이원Logistic회귀분석결과현시,WMHs평분시불리적신경공능결국독립위험인소(OR=1.136,95％CI 1.037～1.245,P=0.008).결론 엄중WMHs불증가급성결혈성졸중정맥rt-PA용전후적출혈전화풍험,단여졸중후불리적신경공능결국유관.
Objective To investigate the relationship between white-matter hyperintensities (WMHs) and hemorrhagic transformation and neurological outcome at 3 months after recombinant tissue plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke.Methods The chnical data of 132 patients with acute ischemic stroke who had received intravenous rt-PA therapy were retrospectively reviewed.The severity of WMHs according to the modified Schelten scale was assessed.Hemorrhagic transformation included hemorrhagic infarct (HI) and cerebral parenchymal hemorrhage (PH).Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale (mRS) at 3 months was also analyzed.Favorable neurological outcome as mRS 0-1 score and unfavorable neurological outcome as mRS 2-6 scores was defined.Results Hemorrhagic transformation was found in 26 patients (19.7％,26/132) among 132 patients receiving intravenous rt-PA treatment.Seventeen patients were HI type and 9 patients were PH type.Multiple Logistic regression analysis showed that baseline American National Institute of Health Stroke Scale (NIHSS) score,diastolic pressure,WMHs score was not correlated with HI type hemorrhagic transformation (P ＞ 0.05) ; and WMHs score was not correlated with PH type hemorrhagic transformation (P ＞0.05),but baseline NIHSS score,diastolic pressure was the independent risk factor of PH type hemorrhagic transformation (P ＜ 0.05).Dicho-Logistic regression analysis showed that WMHs score was the independent risk factor of unfavorable neurological outcome (OR =1.136,95％ CI 1.037-1.245,P =0.008).Conclusion Severe WMHs are not associated with hemorrhagic transformation but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.