CAJ | 학술논문

目的明确脑白质高信号(WMHs)的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.方法连续收集就诊于我科并接受静脉rt-PA溶栓治疗的急性缺血性卒中患者144例,分析其临床资料,利用改良Schelten量表评定脑白质高信号严重程度,出血转化根据欧洲协作性急性卒中研究Ⅲ(ECASSⅢ)标准评定,改良Rankin评分≥2分定义为神经功能结局不利.结果 144例接受静脉rt-PA溶栓治疗的患者年龄为(66.6±12.6)岁,女性46例(31.9％),发病至溶栓时间为(241.9 ±88.4) min,溶栓前NIHSS为(12.31±5.98)分,脑白质高信号评分为(7.81±4.93)分.共28例(19.4％)影像学表现为溶栓后出血转化,其中18例(12.5％)为出血性梗死(HI)型,10例(6.9％)为脑实质出血(PH)型.经多元Logistic回归分析提示,WMHs严重程度不增加HI型风险(OR=1.017,95％ CI0.919 ～1.126,P =0.744),对PH型风险亦无增加(OR=1.025,95％CI0.895 ～1.175,P=0.716).二元Logistic回归分析提示,脑白质高信号严重程度是神经功能结局不利的独立危险因素(OR=1.135,95％ CI1.036 ～1.244,P=0.007).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,但与卒中后不利神经功能结局有关.
목적 명학뇌백질고신호(WMHs)적엄중정도여급성결혈성졸중환자정맥중조조직형섬용매원격활제(rt-PA)용전후적출혈전화이급3개월후신경공능결국지간적관계.방법 련속수집취진우아과병접수정맥rt-PA용전치료적급성결혈성졸중환자144례,분석기림상자료,이용개량Schelten량표평정뇌백질고신호엄중정도,출혈전화근거구주협작성급성졸중연구Ⅲ(ECASSⅢ)표준평정,개량Rankin평분≥2분정의위신경공능결국불리.결과 144례접수정맥rt-PA용전치료적환자년령위(66.6±12.6)세,녀성46례(31.9％),발병지용전시간위(241.9 ±88.4) min,용전전NIHSS위(12.31±5.98)분,뇌백질고신호평분위(7.81±4.93)분.공28례(19.4％)영상학표현위용전후출혈전화,기중18례(12.5％)위출혈성경사(HI)형,10례(6.9％)위뇌실질출혈(PH)형.경다원Logistic회귀분석제시,WMHs엄중정도불증가HI형풍험(OR=1.017,95％ CI0.919 ～1.126,P =0.744),대PH형풍험역무증가(OR=1.025,95％CI0.895 ～1.175,P=0.716).이원Logistic회귀분석제시,뇌백질고신호엄중정도시신경공능결국불리적독립위험인소(OR=1.135,95％ CI1.036 ～1.244,P=0.007).결론 엄중WMHs불증가급성결혈성졸중정맥rt-PA용전후적출혈전화풍험,단여졸중후불리신경공능결국유관.
Objective To investigate the relationship between white-matter hyperintensities (WMHs) and hemorrhagic transformation (HT) and neurological outcome at 3 months after recombinant tissue plasminogen activator (rt-PA) treatment in patients with acute ischemic stroke.Methods Prospective clinical,laboratory,and radiological data from patients with acute ischemic stroke who had received intravenous rt-PA therapy in our hospital were retrospectively reviewed.The severity of WMHs according to the modified Scheltens scale was assessed.Hemorrhagic transformation after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale (mRS) at 3 months were also analyzed.Favorable outcome as mRS 0-1 and unfavorable outcome as mRS 2-6 were defined.Results One hundred and forty-four patients receiving intravenous rt-PA treatment in this study were finally enrolled.The mean age was (66.6 ± 12.6) years old,46(31.9％) were women,pretreatment National Institutes of Health Stroke Scale score was 12.31 ±5.98,door-to-needle time was (241.9 ±88.4) minutes,and WMHs score was 7.81 ± 4.93.Postlytic radiological HT was found in 28 patients (19.4％).Hemorrhagic infarction (HI) was found in 18 (12.5％) patients while parenchymal hematoma (PH) was found in 10 (6.9％) patients.Logistic regression analysis showed that severity of WMHs was not associated with hemorrhagic transformation (HI and PH,OR =1.017,95％ CI 0.919-1.126,P =0.744; OR =1.025,95％ CI0.895-1.175,P =0.716,respectively),but independently associated with unfavorable outcome (OR=1.135,95％CI 1.036-1.244,P=0.007).Conclusions Severe WMHs are not associated with hemorrhagic transformation but independently associated with unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.