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目的阐明中国汉族人急性脑卒中溶栓后出血性转化与临床预后的关系。方法采用二分类Logistic回归回顾性分析脑卒中溶栓队列出血性转化和预后关系。结果共纳入102例患者,男性44例(43.1%),女性58例(56.9%);年龄中位数73岁;溶栓无出血转化73例(74.5%),梗塞性出血12例(12.2%),脑实质性出血13例(13.3%)。预后良好44例(43.6%),预后不良57例(56.4%)。溶栓后ASPECT评分可预示出血性转化(OR0.15)和预后不良(OR0.20);血肌钙蛋白水平同样预示出血转化(OR27.42)和不良结局(OR12.16)。其他独立影响因素为脉搏数(OR2.18)和NIHSS评分(OR2.00),但出血转化本身与预后无相关性。结论溶栓后低ASPECT评分、基线高血肌钙蛋白水平、高NIHSS评分和高脉搏计数可以预测溶栓后3个月不良预后,出血性转化可能与预后无关。
Objective To elucidate the relationship between hemorrhagic transformation after thrombolysis and clinical prognosis in acute stroke in Chinese Han population. Methods Logistic regression was used to analyze the relationship between hemorrhagic transformation and prognosis in patients with stroke. Results A total of 102 patients were enrolled in this study. There were 44 males (43.1%) and 58 females (56.9%) with a median age of 73 years. There were 73 cases (74.5%) without hemorrhage after thrombolysis and 12 cases (12.2% ), 13 cases of parenchymal hemorrhage (13.3%). The prognosis was good in 44 (43.6%) and poor prognosis in 57 (56.4%). The ASPECT score after thrombolysis predicts hemorrhagic transformation (OR0.15) and poor prognosis (OR0.20). The level of serum troponin also predicts hemorrhage (OR27.42) and adverse outcome (OR12.16). Other independent influencing factors were pulse rate (OR2.18) and NIHSS score (OR2.00), but there was no correlation between hemorrhagic transformation and prognosis. Conclusions The low ASPECT score, baseline hyperkalemia, high NIHSS score and high pulse rate after thrombolysis can predict the poor prognosis at 3 months after thrombolysis, and the hemorrhagic transformation may not be related to prognosis.