CAJ | 학술논문

目的：研究并探讨影响后循环脑梗塞溶栓治疗后出现出血性转化的危险因素及与预后相关性。方法：150例后循环梗死患者接受静脉尿激酶（80～150万IU ）溶栓治疗，根据是否有出血性转化分成出血性转化组（ HT）和非出血性转化组（ NHT）两组。观察D－二聚体及纤维蛋白原降解物水平（ FDP ）、血小板、血糖、血脂等的变化；并采用美国国立卫生研究院卒中量表（ NIHSS ）、以修正的Rankin指数评分（ MRS）评价患者神经功能缺损情况，评价后循环溶栓治疗的远期疗效。并对可能与出血性转化相关的因素进行回归分析。结果：HT的发生率为24％；HT组总胆固醇（ TC ）、低密度脂蛋白胆固醇（LDL－C）均显著低于NHT组（P＜0．05）；HT组NIHSS、纤维蛋白原降解物（FDP）、D－二聚体高于NHT组，差异有统计学意义（ P＜0．05）。 Logistic回归分析显示，NIHSS评分、TC、LDL－C、D－二聚体、纤维蛋白原降解物是发生出血性转化的危险因素（ P＜0．05）。尿激酶输注后6h两组患者血浆D－二聚体均有不同程度升高，HT组明显，24h后再次升高。尿激酶输注后12h两组患者FDP 水平均下降，而HT组降低最显著。溶栓后90d两组NIHSS评分及MRS评分均较溶栓前明显降低，有统计学差异（ P＜0．05）。结论：NIHSS评分、FDP、D二聚体、TC、LDL－C是后循环脑梗死发生出血性转化的危险因素，且溶栓治疗能改善患者远期预后。
목적：연구병탐토영향후순배뇌경새용전치료후출현출혈성전화적위험인소급여예후상관성。방법：150례후순배경사환자접수정맥뇨격매（80～150만IU ）용전치료，근거시부유출혈성전화분성출혈성전화조（ HT）화비출혈성전화조（ NHT）량조。관찰D－이취체급섬유단백원강해물수평（ FDP ）、혈소판、혈당、혈지등적변화；병채용미국국립위생연구원졸중량표（ NIHSS ）、이수정적Rankin지수평분（ MRS）평개환자신경공능결손정황，평개후순배용전치료적원기료효。병대가능여출혈성전화상관적인소진행회귀분석。결과：HT적발생솔위24％；HT조총담고순（ TC ）、저밀도지단백담고순（LDL－C）균현저저우NHT조（P＜0．05）；HT조NIHSS、섬유단백원강해물（FDP）、D－이취체고우NHT조，차이유통계학의의（ P＜0．05）。 Logistic회귀분석현시，NIHSS평분、TC、LDL－C、D－이취체、섬유단백원강해물시발생출혈성전화적위험인소（ P＜0．05）。뇨격매수주후6h량조환자혈장D－이취체균유불동정도승고，HT조명현，24h후재차승고。뇨격매수주후12h량조환자FDP 수평균하강，이HT조강저최현저。용전후90d량조NIHSS평분급MRS평분균교용전전명현강저，유통계학차이（ P＜0．05）。결론：NIHSS평분、FDP、D이취체、TC、LDL－C시후순배뇌경사발생출혈성전화적위험인소，차용전치료능개선환자원기예후。
Objective:To investigate the related risk factors of hemorrhagic transformation( HT) in a-cute posterior circulation infarction and relationship with the prognosis.Method:150 acute posterior circula-tion infarction patients accepted thrombolytic therapy.Observed the D-dimer and fibrinogen degradation products(FDP) level, the change of platelets, blood sugar, blood lipids and so on.Used the NIHSS score, the modified Rankin index score ( MRS) nerve function to evaluate the active ability of daily life of patients, observed long-term effect of patients after thrombolysis.Result: The rate of HT was 24%; Compared with NHT group,total cholesterol ( TC) , low-density lipoprotein cholesterol ( LDL-C) ,HT group were much low-er,the difference was statistically significant ( P<0.05 ) .NIHSS score, fibrinogen degradation products (FDP),D -dimer were higher than NHT group, the difference was statistically significant.Logistic regres-sion analysis showed that NIHSS score,TC,LDL-C,D-dimer,FDP were independent risk factors of HT( P<0.05) .After infusing urokinase 6 hours,D-dimer level of two groups was increased,HT group was more sig-nificance,and after 24h,it increased again, fibrinogen degradation products decreased,the lowest point on HT group;Both HT and NHT group’ s NIHSS score and MRS score had significant differences in 90 days( P<0.05).Conclusion:NIHSS score,FDP, D-dimer,TC,LDL-C are independent risk factors for hemorrhagic transformation.Thrombolysis therapy could improve the long-term prognosis.