高龄急性缺血性脑卒中患者静脉溶栓后出血性转化的危险因素分析

Risk factors of hemorrhagic transformation in elderly patients with acute ischemic stroke after intravenous thrombolysis:an analysis of 326 cases

摘要:

目的 探讨高龄急性缺血性脑卒中(AIS)患者静脉溶栓后出血性转化(HT)的危险因素。方法 收集2016年1月至2019年3月海口市第三人民医院急诊科收治的高龄AIS患者326例。根据其静脉溶栓后是否发生HT,分为HT组(51例)和无HT组(275例)。采用SPSS 20.0统计软件进行数据分析。应用单因素分析及多因素logistic回归分析,评价影响高龄AIS患者静脉溶栓后发生HT的危险因素。结果 单因素分析显示,HT组的心房颤动、尿蛋白阳性、溶栓后24h收缩压、血糖、国际标准化比值、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓后24h NIHSS评分及发病至溶栓时间>3h明显高于无HT组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,溶栓后24h收缩压(OR=1.935,95%CI 1.226～4.162)、血糖(OR=2.240,95%CI 1.638～5.237)、溶栓前NIHSS评分(OR=2.435,95%CI 1.805～5.726)、溶栓后24h NIHSS评分(OR=3.381,95%CI 2.216～7.250)及发病至溶栓时间>3h(OR=2.703,95%CI 1.914～6.116)是高龄AIS患者静脉溶栓后发生HT的独立危险因素(P<0.05)。结论 溶栓后24h收缩压、血糖、溶栓前NIHSS评分、溶栓后24h NIHSS评分及发病至溶栓时间>3h是高龄AIS患者静脉溶栓后发生HT的独立危险因素,可为临床溶栓治疗提供参考。

Abstract:

Objective To explore the risk factors of hemorrhagic transformation (HT) in elderly patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods The clinical data of 326 elderly AIS patients undergoing intravenous thrombolysis in our department from January 2016 to March 2019 were retrospectively collected. They were divided into HT group (n=51) and non-HT group (n=275) according to whether HT occurred after intravenous thrombolysis. SPSS statistics 22.0 was used for data analysis. Univariate analysis and multivariate logistic regression were used to analyze the risk factors of HT in elderly patients with AIS after intravenous thrombolysis. Results Univariate analysis showed that atrial fibrillation, positive urinary protein, systolic blood pressure 24h after thrombolysis, blood glucose, international standardized ratio, National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, NIHSS score 24h after thrombolysis and the time from onset to thrombolysis >3h were significantly higher in the HT group than the non-HT group (P<0.05). Multivariate logistic regression analysis indicated that systolic blood pressure (OR=1.935, 95%CI 1.226-4.162), blood glucose (OR=2.240,95%CI 1.638-5.237), NIHSS score before thrombolysis (OR=2.435, 95%CI 1.805-5.726) and 24h after thrombolysis (OR=3.381,95%CI 2.216-7.250) and thrombolytic time >3h (OR=2.703,95%CI 1.914-6.116) were independent risk factors for HT after intravenous thrombolysis in elderly AIS patients (P<0.05). Conclusion Systolic blood pressure 24h after thrombolysis, blood glucose, NIHSS scores before and 24h after thrombolysis and time from onset to thrombolysis >3h are independent risk factors for HT in elderly patients with AIS after intravenous thrombolysis, and these indicators can provide reference for clinical thrombolysis treatment.