CAJ | 학술논문

目的：探讨心源性脑梗死（CE）及大动脉粥样硬化性脑梗死（LAA）出血转化（HT）的相关危险因素。方法：回顾性分析2009年1月至2012年12月急性前循环脑梗死患者560例（其中CE组186例，LAA组374例），按是否发生HT分为HT亚组和非HT亚组。收集患者既往高血压病史、糖尿病病史及心房颤动病史，入院24 h内的血压、空腹血糖（FBG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、影像学检测到的梗死面积，入院后的抗凝、抗血小板及他汀类药物治疗情况。首先进行单因素分析，对差异有统计学意义的指标进行多因素Logistic回归分析，分别得出两种类型脑梗死HT的危险因素。结果：LAA组与CE组患者间HT的发生率差异有统计学意义（P=0.005，OR=1.946，95%CI：1.224～3.093）。多因素Logistic回归分析显示，在LAA组，他汀类药物治疗（OR=0.212，95%CI：0.067～0.672）、抗血小板治疗（OR=0.170，95%CI：0.074～0.388）及美国国立卫生院神经功能缺损评分（NIHSS）评分（OR=1.088，95%CI：1.02～1.16）与HT显著相关，而在CE组， FBG（OR=2.168，95%CI：1.131～4.155）和抗血小板治疗（OR=2.224，95%CI：1.142～4.330）为HT的独立危险因素。结论：CE患者较LAA患者HT发生率高。抗血小板治疗及他汀类药物治疗为LAA患者HT的保护因素，入院时NIHSS评分与LAA患者HT相关，而FBG高及抗血小板治疗为CE患者HT的危险因素。
목적：탐토심원성뇌경사（CE）급대동맥죽양경화성뇌경사（LAA）출혈전화（HT）적상관위험인소。방법：회고성분석2009년1월지2012년12월급성전순배뇌경사환자560례（기중CE조186례，LAA조374례），안시부발생HT분위HT아조화비HT아조。수집환자기왕고혈압병사、당뇨병병사급심방전동병사，입원24 h내적혈압、공복혈당（FBG）、총담고순（TC）、저밀도지단백담고순（LDL-C）、영상학검측도적경사면적，입원후적항응、항혈소판급타정류약물치료정황。수선진행단인소분석，대차이유통계학의의적지표진행다인소Logistic회귀분석，분별득출량충류형뇌경사HT적위험인소。결과：LAA조여CE조환자간HT적발생솔차이유통계학의의（P=0.005，OR=1.946，95%CI：1.224～3.093）。다인소Logistic회귀분석현시，재LAA조，타정류약물치료（OR=0.212，95%CI：0.067～0.672）、항혈소판치료（OR=0.170，95%CI：0.074～0.388）급미국국립위생원신경공능결손평분（NIHSS）평분（OR=1.088，95%CI：1.02～1.16）여HT현저상관，이재CE조， FBG（OR=2.168，95%CI：1.131～4.155）화항혈소판치료（OR=2.224，95%CI：1.142～4.330）위HT적독립위험인소。결론：CE환자교LAA환자HT발생솔고。항혈소판치료급타정류약물치료위LAA환자HT적보호인소，입원시NIHSS평분여LAA환자HT상관，이FBG고급항혈소판치료위CE환자HT적위험인소。
Objective: To contrast the incidence of HT between large artery atherothrombosis (LAA) and cardioembolism (CE), and to investgate the risk factors for hemorhagic transformation (HT) in patients with an-terior circulation infarction who was attributed to cardioembolism (CE) or large artery atherothrombosis (LAA). Methods: The clinical data of 560 acute ischemic stroke patients admitted to Wenzhou First Hospital Afifliated to Wenzhou Medical University between January 2010 and December 2012 were retrospectively collected. They were divided into HT group and non-HT group. Baseline demographic and clinical information collected includ-ed gender, age at onset, hypertension, diabetes, atrial ifbrillation, systolic blood pressure and diastolic blood pres-sure levels, fasting blood glucose level, levels of TC and low-density lipoprotein cholesterol, National Institute of Health Stroke Scale (NIHSS) score at admission, infarct size, use of antiplatelet or anticoagulant medications and statins treatment. Univariate analysis was performed using idependent-Student’s t-tests (for continuous variables) and chi-square test (for categorical variables) for each of the predictors of interest. Subsequent multivariable modeling included the presence of HT as the dependent variable in stepwise logistic regression.Results: Statins use [odds ratio (OR)=0.212, 95% confidence interval (CI): 0.067-0.672], antiplatelet treatment (OR=0.170, 95%CI: 0.074-0.388) and the NIHSS score (OR=1.088, 95%CI: 1.02-1.16) were predictors of hemorrhagic transformation in LAA patients, while antiplatelet treatment (OR=2.224, 95%CI: 1.142-4.330) and blood glucose level (OR=2.168, 95%CI: 1.131-4.155) in CE patients.Conclusion: A higher HT rate found in the CE group than that in the LAA group. In LAA patients, statins used and antiplatelet treatment can lower the incidence of HT while NIHSS score may be a risk factor.But antiplatelet trentment and high blood glucose level may be the possible risk factors in CE patients.