CAJ | 학술논문

目的：探讨急性脑梗死后非溶栓患者发生出血转化的影响因素。方法基于成都卒中登记库，前瞻性连续纳入2010年1月至2013年12月急性脑梗死后1周内入住华西医院神经内科的患者。将患者依据是否发生出血转化分为出血转化组与非出血转化组，对出血转化患者，依据是否伴有症状、体征加重分为症状性出血转化组（SHT组）和无症状性出血转化组（ASHT组）。收集所有患者的基线资料及血管病变的危险因素、入院情况并进行组间比较。将单因素分析结果P＜0.1的变量纳入多因素Logistic回归分析，确认出血转化的独立影响因素。结果共纳入患者2598例，249例（9.6％）患者发生出血转化，其中28例（1.1％）为SHT。出血转化组与非出血转化组比较，男性、高血压病、高脂血症、心房颤动、饮酒及吸烟比例、血糖、胆固醇、低密度脂蛋白、美国国立卫生研究院卒中量表（NIHSS）评分及急性卒中治疗 Org10172试验（TOAST）分型差异均有统计学意义（均P＜0.05）。SHT组与ASHT组比较，所有影响因素差异无统计学意义（P＞0.05）。多因素Logistic回归分析显示，出血转化独立影响因素为高脂血症（OR ＝0.588，95％ CI：0.374～0.924，P ＝0.021）、心房颤动（OR ＝3.188，95％ CI：2.159～4.707，P ＜0.001）、血糖（OR ＝1.081，95％CI：1.044～1.119，P ＜0.001）、NIHSS评分（OR ＝1.305，95％CI：1.170～1.455，P ＜0.001），高脂血症与出血转化呈负相关，心房颤动、血糖、NIHSS评分与出血转化呈正相关；TOAST分型中，相对于大动脉粥样硬化型卒中，小动脉闭塞型脑梗死与出血转化呈负相关（OR＝0.315，95％CI：0.167～0.596，P＜0.001）。多因素Logistic回归分析中，去除自变量心房颤动，则TOAST分型中，对比大动脉粥样硬化型卒中，心源性栓塞型卒中与出血转化呈独立正相关（OR＝2．823，95％CI：1．946～4.095，P＜0．001）。结论高脂血症、心房颤动、血糖、NIHSS评分及TOAST分型与急性脑梗死后非溶栓患者出血转化具有独立相关性。目的：探討急性腦梗死後非溶栓患者髮生齣血轉化的影響因素。方法基于成都卒中登記庫，前瞻性連續納入2010年1月至2013年12月急性腦梗死後1週內入住華西醫院神經內科的患者。將患者依據是否髮生齣血轉化分為齣血轉化組與非齣血轉化組，對齣血轉化患者，依據是否伴有癥狀、體徵加重分為癥狀性齣血轉化組（SHT組）和無癥狀性齣血轉化組（ASHT組）。收集所有患者的基線資料及血管病變的危險因素、入院情況併進行組間比較。將單因素分析結果P＜0.1的變量納入多因素Logistic迴歸分析，確認齣血轉化的獨立影響因素。結果共納入患者2598例，249例（9.6％）患者髮生齣血轉化，其中28例（1.1％）為SHT。齣血轉化組與非齣血轉化組比較，男性、高血壓病、高脂血癥、心房顫動、飲酒及吸煙比例、血糖、膽固醇、低密度脂蛋白、美國國立衛生研究院卒中量錶（NIHSS）評分及急性卒中治療 Org10172試驗（TOAST）分型差異均有統計學意義（均P＜0.05）。SHT組與ASHT組比較，所有影響因素差異無統計學意義（P＞0.05）。多因素Logistic迴歸分析顯示，齣血轉化獨立影響因素為高脂血癥（OR ＝0.588，95％ CI：0.374～0.924，P ＝0.021）、心房顫動（OR ＝3.188，95％ CI：2.159～4.707，P ＜0.001）、血糖（OR ＝1.081，95％CI：1.044～1.119，P ＜0.001）、NIHSS評分（OR ＝1.305，95％CI：1.170～1.455，P ＜0.001），高脂血癥與齣血轉化呈負相關，心房顫動、血糖、NIHSS評分與齣血轉化呈正相關；TOAST分型中，相對于大動脈粥樣硬化型卒中，小動脈閉塞型腦梗死與齣血轉化呈負相關（OR＝0.315，95％CI：0.167～0.596，P＜0.001）。多因素Logistic迴歸分析中，去除自變量心房顫動，則TOAST分型中，對比大動脈粥樣硬化型卒中，心源性栓塞型卒中與齣血轉化呈獨立正相關（OR＝2．823，95％CI：1．946～4.095，P＜0．001）。結論高脂血癥、心房顫動、血糖、NIHSS評分及TOAST分型與急性腦梗死後非溶栓患者齣血轉化具有獨立相關性。
목적：탐토급성뇌경사후비용전환자발생출혈전화적영향인소。방법기우성도졸중등기고，전첨성련속납입2010년1월지2013년12월급성뇌경사후1주내입주화서의원신경내과적환자。장환자의거시부발생출혈전화분위출혈전화조여비출혈전화조，대출혈전화환자，의거시부반유증상、체정가중분위증상성출혈전화조（SHT조）화무증상성출혈전화조（ASHT조）。수집소유환자적기선자료급혈관병변적위험인소、입원정황병진행조간비교。장단인소분석결과P＜0.1적변량납입다인소Logistic회귀분석，학인출혈전화적독립영향인소。결과공납입환자2598례，249례（9.6％）환자발생출혈전화，기중28례（1.1％）위SHT。출혈전화조여비출혈전화조비교，남성、고혈압병、고지혈증、심방전동、음주급흡연비례、혈당、담고순、저밀도지단백、미국국립위생연구원졸중량표（NIHSS）평분급급성졸중치료 Org10172시험（TOAST）분형차이균유통계학의의（균P＜0.05）。SHT조여ASHT조비교，소유영향인소차이무통계학의의（P＞0.05）。다인소Logistic회귀분석현시，출혈전화독립영향인소위고지혈증（OR ＝0.588，95％ CI：0.374～0.924，P ＝0.021）、심방전동（OR ＝3.188，95％ CI：2.159～4.707，P ＜0.001）、혈당（OR ＝1.081，95％CI：1.044～1.119，P ＜0.001）、NIHSS평분（OR ＝1.305，95％CI：1.170～1.455，P ＜0.001），고지혈증여출혈전화정부상관，심방전동、혈당、NIHSS평분여출혈전화정정상관；TOAST분형중，상대우대동맥죽양경화형졸중，소동맥폐새형뇌경사여출혈전화정부상관（OR＝0.315，95％CI：0.167～0.596，P＜0.001）。다인소Logistic회귀분석중，거제자변량심방전동，칙TOAST분형중，대비대동맥죽양경화형졸중，심원성전새형졸중여출혈전화정독립정상관（OR＝2．823，95％CI：1．946～4.095，P＜0．001）。결론고지혈증、심방전동、혈당、NIHSS평분급TOAST분형여급성뇌경사후비용전환자출혈전화구유독립상관성。
Objective To investigate the influencing factors of hemorrhagic transformation in non-thrombolysis patients after acute cerebral infarction. Methods According to Chengdu Stroke Registry Project,2598 consecutive patients with acute cerebral infarction admitted to the Department of Neurology,West China Hospital within 1 week of attack from January 2010 to December 2013 were enrolled prospectively. The patients were divided into a hemorrhagic transformation group and a non-hemorrhagic transformation group according to whether they had hemorrhagic transformation or not. As for patients with hemorrhagic transformation,they were divided into a symptomatic hemorrhagic transformation (SHT)group and an asymptomatic hemorrhagic transformation (ASHT)group according to whether they had aggravation of symptom and sign. The baseline data of all patients were collected and compared between the groups. The P<0. 1 variables of the univariate analysis result were enrolled in multivariate logistic regression analysis in order to identify the independent influencing factor of hemorrhagic transformation. Results In 2598 patients,249 (9. 6%)had hemorrhagic transformation,28 of them (1. 1%)were SHT and 221 (8. 5%)were ASHT. There were significant differences in male,hypertension,dyslipidemia,atrial fibrillation,drinking and smoking ratio,blood glucose,cholesterol,low density lipoprotein cholesterol, National Institutes of Health Stroke Scale (NHISS)scores,and the trial of Org 1072 in acute stroke treatment (TOAST)classification between the HT group and the non-HT group (all P<0. 05). There were no significant difference in the related influencing factors between the SHT group and the ASHT group (all P>0. 05). The results of multivariate logistic regression analysis showed that dyslipidemia (OR,0. 588, 95%CI 0. 374-0. 924,P=0. 021)was negatively correlated with hemorrhagic transformation. Atrial fibrillation (OR,3. 188,95%CI 2. 159-4. 707,P<0. 001),blood glucose (OR,1. 081,95%CI 1. 044-1. 119,P<0.001),and NHISS score (OR,1. 305,95%CI 1. 170-1. 455,P<0. 001)were positively correlated with hemorrhagic transformation. In TOAST classification,relative to the large atherosclerotic stroke,the small artery occlusive cerebral infarction was negatively correlated with hemorrhagic transformation (OR,0. 315, 95%CI 0. 167-0. 596,P<0. 001). After removing the influencing factor of atrial fibrillation,compared with the large artery atherosclerotic stroke,cardioembolism stroke was positively correlated with hemorrhagic transformation (OR,2. 823,95%CI 1. 946-4. 095,P<0. 001). Conclusion Dyslipidemia,atrial fibrillation,blood glucose,NHISS score and TOAST classification were independently associated with hemorrhagic transformation in non-thrombolysis patients after acute cerebral infarction.