CAJ | 학술논문

目的研究脑出血转化与血脂代谢的相关性,并探讨脑出血转化早期的积极防治方法. 方法选择广州中医药大学附属中山医院神经内科自2009年6月至2010年12月收治的资料完整的急性脑梗死患者348例,所有患者均于入院次日行空腹血脂检查,入院后1周行头颅CT或MRI复查判断是否合并脑出血转化,登记相关危险因素并进行多变量Logistic回归分析,探索脑出血转化的危险因素. 结果 348例患者中合并脑出血转化35例,无脑出血转化313例.与非脑出血转化组比较,脑出血转化组患者糖尿病、心房纤颤、尿激酶溶栓发生率较高,脑白质疏松、脑微出血(CMB)发生率较低,总胆固醇(TCH)、低密度脂蛋白(LDL)及高密度脂蛋白(HDL)水平较低,差异均有统计学意义(P＜0.05);2组患者中不同类型脑梗死(TOAST分型)的分布不同,差异有统计学意义(P＜0.05);多变量Logistic回归分析提示脑出血转化的危险因素包括心源性脑栓塞、不明病因脑梗死、糖尿病及高美国国立卫生院神经功能缺损评分(NIHSS),保护性因素为LDL. 结论急性脑梗死患者入院时低水平LDL与脑出血转化相关,建议对于低水平LDL、高NIHSS评分及心源性脑栓塞患者,谨慎强化降脂治疗,及早预防脑出血转化的发生.
목적 연구뇌출혈전화여혈지대사적상관성,병탐토뇌출혈전화조기적적겁방치방법. 방법 선택엄주중의약대학부속중산의원신경내과자2009년6월지2010년12월수치적자료완정적급성뇌경사환자348례,소유환자균우입원차일행공복혈지검사,입원후1주행두로CT혹MRI복사판단시부합병뇌출혈전화,등기상관위험인소병진행다변량Logistic회귀분석,탐색뇌출혈전화적위험인소. 결과 348례환자중합병뇌출혈전화35례,무뇌출혈전화313례.여비뇌출혈전화조비교,뇌출혈전화조환자당뇨병、심방섬전、뇨격매용전발생솔교고,뇌백질소송、뇌미출혈(CMB)발생솔교저,총담고순(TCH)、저밀도지단백(LDL)급고밀도지단백(HDL)수평교저,차이균유통계학의의(P＜0.05);2조환자중불동류형뇌경사(TOAST분형)적분포불동,차이유통계학의의(P＜0.05);다변량Logistic회귀분석제시뇌출혈전화적위험인소포괄심원성뇌전새、불명병인뇌경사、당뇨병급고미국국립위생원신경공능결손평분(NIHSS),보호성인소위LDL. 결론 급성뇌경사환자입원시저수평LDL여뇌출혈전화상관,건의대우저수평LDL、고NIHSS평분급심원성뇌전새환자,근신강화강지치료,급조예방뇌출혈전화적발생.
Objective To investigate the relationship between hemorrhagic transformation (HT)after acute ischemic infarction and lipid profile,and to analyze the precautions of HT.Methods Three hundred and forty-eight patients with acute infarction,admitted to our hospital from June 2009 to December 2010,were included.The fasting lipid profile was examined the next morning of hospitalization.All patients were performed MRI GRE-T2*WI or CT one week after hospitalization to detect the presence of cerebral microbleeds (CMB) and hemorrhagic transformation.The lipid profiles,including total cholesterol (TCH),triglyceride (TG),low-density lipoprotein (LDL) and high-density lipoprotein (HDL),were detected to analyze the relationship with HT.Logistic regression analysis was used to assess the relationship between HT and related risk factors by Forward Stepwise.Results In all the 348 patients,HT was noted in 35 patients and non-HT in 313.As compared with non-PH group,HT group had lower levels ofTCH,HDL and LDL,lower rates ofleukoaraiosis and CMB,but higher rates of diabetes,atrial fibrillation and urokinase thrombolysis,with significant differences (P＜0.05).The distribution of infarction types (TOAST) was significantly different (P＜0.05).The multivariate binary Logistic regression showed that risk factors of HT were cardioembolic infarction,undetermined etiology infarction,high scores of NIHSS and diabetes,while the protective factor was LDL (OR=0.654,95％CI:0.430-0.996,P=0.048).Conclusions Low level of LDL may be associated with increased HT after acute ischemic infarct,so for those patients with low level of LDL at admission,high scores of NIHSS and cardioemoblic infarction,aggressive lowering-lipid treatment should be prescribed cautiously.