中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2014年
3期
7-10
,共4页
张士亮%张鹏%宋冉%张子宪%李林文
張士亮%張鵬%宋冉%張子憲%李林文
장사량%장붕%송염%장자헌%리림문
脑梗死出血性转化%肿瘤坏死因子-α%危险因素%大面积脑梗死%脑栓塞
腦梗死齣血性轉化%腫瘤壞死因子-α%危險因素%大麵積腦梗死%腦栓塞
뇌경사출혈성전화%종류배사인자-α%위험인소%대면적뇌경사%뇌전새
Hemorrhagic transformation of cerebral infarction%Tumor necrosis factor-α%Risk factors%Massive cerebral infarction%Cerebral embolism
目的 观察急性脑梗死尤其伴发出血性转化患者血清肿瘤坏死因子-α(TNF-α)含量水平的动态变化,探讨TNF-α在脑梗死出血性转化发病机制中所起的作用及脑梗死出血性转化患者的临床特点和相关危险因素.方法 将2011年2月至2012年6月收治的198例脑梗死患者分为脑梗死出血性转化组(48例)及单纯脑梗死组(150例),采用放射免疫分析法于发病第1、4、7、10天连续检测48例急性脑梗死出血性转化患者、150例单纯脑梗死患者和45例正常对照组TNF-α含量,进行各组间比较分析.采用Logistic回归模型分析急性脑梗死出血性转化的危险因素.结果 急性脑梗死出血性转化患者于发病第1天TNF-α开始升高(P＜0.05),第4天达到峰值水平(P＜0.01),然后逐渐下降,至第10天时仍高于对照组和单纯脑梗死组(P＜0.05).梗死体积大、继发出血量多,TNF-α水平就越高,与其他各组相比差异有统计学意义(P ＜0.05,＜0.01).研究发现脑栓塞、皮质梗死、大面积脑梗死、高血糖为脑梗死出血性转化的独立危险因素,溶栓治疗可增加出血性转化的危险性,而抗凝治疗与出血转化无明显相关性.结论 TNF-α水平的动态变化与急性脑梗死,尤其伴发出血性转化的发生发展明显相关,脑梗死出血性转化患者血清TNF-α水平升高明显;TNF-α水平升高持续时间越长,脑组织损害就越严重.其中心源性脑栓塞、皮质部位梗死、大面积脑梗死、高血糖、溶栓治疗与脑梗死出血性转化有一定的相关性.
目的 觀察急性腦梗死尤其伴髮齣血性轉化患者血清腫瘤壞死因子-α(TNF-α)含量水平的動態變化,探討TNF-α在腦梗死齣血性轉化髮病機製中所起的作用及腦梗死齣血性轉化患者的臨床特點和相關危險因素.方法 將2011年2月至2012年6月收治的198例腦梗死患者分為腦梗死齣血性轉化組(48例)及單純腦梗死組(150例),採用放射免疫分析法于髮病第1、4、7、10天連續檢測48例急性腦梗死齣血性轉化患者、150例單純腦梗死患者和45例正常對照組TNF-α含量,進行各組間比較分析.採用Logistic迴歸模型分析急性腦梗死齣血性轉化的危險因素.結果 急性腦梗死齣血性轉化患者于髮病第1天TNF-α開始升高(P＜0.05),第4天達到峰值水平(P＜0.01),然後逐漸下降,至第10天時仍高于對照組和單純腦梗死組(P＜0.05).梗死體積大、繼髮齣血量多,TNF-α水平就越高,與其他各組相比差異有統計學意義(P ＜0.05,＜0.01).研究髮現腦栓塞、皮質梗死、大麵積腦梗死、高血糖為腦梗死齣血性轉化的獨立危險因素,溶栓治療可增加齣血性轉化的危險性,而抗凝治療與齣血轉化無明顯相關性.結論 TNF-α水平的動態變化與急性腦梗死,尤其伴髮齣血性轉化的髮生髮展明顯相關,腦梗死齣血性轉化患者血清TNF-α水平升高明顯;TNF-α水平升高持續時間越長,腦組織損害就越嚴重.其中心源性腦栓塞、皮質部位梗死、大麵積腦梗死、高血糖、溶栓治療與腦梗死齣血性轉化有一定的相關性.
목적 관찰급성뇌경사우기반발출혈성전화환자혈청종류배사인자-α(TNF-α)함량수평적동태변화,탐토TNF-α재뇌경사출혈성전화발병궤제중소기적작용급뇌경사출혈성전화환자적림상특점화상관위험인소.방법 장2011년2월지2012년6월수치적198례뇌경사환자분위뇌경사출혈성전화조(48례)급단순뇌경사조(150례),채용방사면역분석법우발병제1、4、7、10천련속검측48례급성뇌경사출혈성전화환자、150례단순뇌경사환자화45례정상대조조TNF-α함량,진행각조간비교분석.채용Logistic회귀모형분석급성뇌경사출혈성전화적위험인소.결과 급성뇌경사출혈성전화환자우발병제1천TNF-α개시승고(P＜0.05),제4천체도봉치수평(P＜0.01),연후축점하강,지제10천시잉고우대조조화단순뇌경사조(P＜0.05).경사체적대、계발출혈량다,TNF-α수평취월고,여기타각조상비차이유통계학의의(P ＜0.05,＜0.01).연구발현뇌전새、피질경사、대면적뇌경사、고혈당위뇌경사출혈성전화적독립위험인소,용전치료가증가출혈성전화적위험성,이항응치료여출혈전화무명현상관성.결론 TNF-α수평적동태변화여급성뇌경사,우기반발출혈성전화적발생발전명현상관,뇌경사출혈성전화환자혈청TNF-α수평승고명현;TNF-α수평승고지속시간월장,뇌조직손해취월엄중.기중심원성뇌전새、피질부위경사、대면적뇌경사、고혈당、용전치료여뇌경사출혈성전화유일정적상관성.
Objective To investigate the dynamic changes of serum tumor necrosis factor-α (TNF-α) levels in patients with acute cerebral infarction especially with hemorrhagic transformation (HT),and investigate the effect of TNF-α on the pathogenesis of hemorrhagic transformation of acute cerebral infarction,and the clinical feature and the risk factors of hemorrhagic transformation of cerebral infarction.Methods One hundred and ninety-eight patients with cerebral infarction and 45 normal controls were included into this study from February 2011 to June 2012.There were 48 patients with hemorrhagic transformation of acute cerebral infarction,and 150 cases of purely cerebral infarction.Radioimmunoassay was used to continuously detect the serum levels of TNF-α on 1 st,4 th,7 th and 10 th day in all patients and normal controls.Logistic regression analysis was used to find out the risk factors of hemorrhagic transformation of cerebral infarction.Results Serum levels of TNF-α in acute cerebral infarction patients with hemorrhagic transformation began to rise on the first day of onset (P ＜ O.05),and reached peak levels on the fourth day (P ＜ 0.01),and then decreased gradually,but was still high-er than that in normal control group and purely cerebral infarction group on the tenth day (P ＜ 0.05) As the focal infarction size and the hematoma presented more larger,the serum TNF-α level would be more higher.Compared with other groups,the differences were significant (P ＜ 0.05 or ＜ 0.01).Cerebral embolism,cerebral cortex infarction,massive cerebral infarction,hyperglycemia were the independent risk factors for the hemorrhagic transformation of cerebral infarction.The thrombolytic therapy could increase the risk of hemorrhagic transformation,but anticoagulation therapy was not related to the hemorrhagic transformation.Conclusions The dynamic change of serum TNF-α levels is correlated with the occurrence and development of cerebral infarction especially with hemorrhagic transformation (HT),the serum TNF-α level in hemorrhagic transformation of cerebral infarction is higher and the elevated levels of TNF-α keep more longer,the brain damage is more serious.Cerebral embolism,cerebral cortex infarction,massive cerebral infarction,hyperglycemia are correlated with HT.Thrombolytic therapy is correlated with the occurrence of hemorrhagic transformation of cerebral infarction.
