急性大面积脑梗死后非溶栓患者发生出血转化的影响因素

刘利君; 刘雪云; 吴小三; 邱菊; 吴桐; 韩永升; 王训

doi:10.16766/j.cnki.issn.1674-4152.001944

急性大面积脑梗死后非溶栓患者发生出血转化的影响因素

doi: 10.16766/j.cnki.issn.1674-4152.001944

1.
安徽医科大学第二附属医院神经内科，安徽合肥 230601
2.
安徽中医药大学神经病学研究所，安徽合肥 230031

基金项目:

国家自然科学基金 81774425

详细信息

通讯作者:
王训，E-mail: neurodoc@163.com

中图分类号: R743
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- 文章访问数: 144
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- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2020-11-25
- 网络出版日期: 2022-02-16

Influencing factors of hemorrhagic transformation in non-thrombolytic patients after acute large area cerebral infarction

1.
Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China

摘要

摘要: 目的通过分析大面积脑梗死出血转化组和无出血转化组中各因素的差异，探讨急性大面积脑梗死非溶栓患者发生出血转化的影响因素，为预后的判断提供依据。方法收集2018年1月—2019年12月就诊于安徽医科大学第二附属医院神经内科的急性大面积脑梗死并且未接受静脉溶栓的患者114例，收集患者一般资料，脑卒中危险因素，入院时血钙、血镁水平等，分析出血转化组和无出血转化组之间有无差异。结果本研究共纳入患者114例，其中无出血转化组88例，出血转化组26例。单因素分析显示出血转化组合并心房颤动患者显著多于无出血转化组(P＜0.05)，低密度脂蛋白胆固醇、血钙、血镁水平显著低于无出血转化组(均P＜0.05)。多因素logistic分析显示心房颤动与大面积脑梗死非溶栓患者发生出血转化呈正相关(OR=4.731, 95%CI 1.594~14.044，P=0.005)，血镁水平与大面积脑梗死非溶栓患者发生出血转化呈负相关(OR=0.000, 95% CI 0.000~0.095，P=0.006)。结论房颤、低血镁可能是急性大面积脑梗死出血转化的独立危险因素。
- 大面积脑梗死 /
- 出血转化 /
- 血镁
Abstract: Objective This study was aimed to explore the influencing factors of hemorrhagic transformation (HT) in non-thrombolytic patients with acute massive cerebral infarction by analyzing the differences in factors between the massive cerebral infarction hemorrhage transformation group and the non-hemorrhage transformation group, and the basis for prognosis judgment was provided. Methods Count patients with acute massive cerebral infarctions and did not receive thrombolysis in the Department of Neurology of the Second Affiliated Hospital of Anhui Medical University from January 2018 to December 2019, we collected general information of patients, risk factors of stroke, the levels of blood calcium and magnesium on admission, and analyze the difference between the hemorrhage transformation group and the non-hemorrhage transformation group. Results A total of 114 patients were enrolled in this study, of which 88 were in the group without hemorrhage transformation and 26 were in the group with hemorrhage transformation. Univariate analysis showed that the patients with hemorrhage transformation combined with atrial fibrillation were significantly more than those without hemorrhage transformation (P < 0.05), and the levels of low-density lipoprotein cholesterol, blood calcium, and magnesium were also significantly lower than those in the hemorrhage transformation group (all P < 0.05). Multivariate logistic analysis showed that atrial fibrillation was positively correlated with hemorrhagic transformation in non-thrombolytic patients with massive cerebral infarction (OR=4.731, 95% CI: 1.594-14.044, P=0.005), and There was an negative correlation between serum magnesium and hemorrhagic transformation in non-thrombolytic patients with cerebral infarction (OR=0.000, 95% CI: 0.000-0.095, P=0.006). Conclusion Atrial fibrillation and hypomagnesemia may be independent risk factors for hemorrhagic transformation of acute massive cerebral infarction.
- Massive cerebral infarction /
- Hemorrhagic transformation /
- Blood magnesium

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表 1 2组急性大面积脑梗死患者一般资料比较 (例)

组别	例数	性别		年龄 (x±s，岁)	高血压		糖尿病		心房颤动		吸烟史		饮酒史
组别	例数	男性	女性	年龄 (x±s，岁)	有	无	有	无	有	无	有	无	有	无
出血转化组	26	11	15	69.27±13.79	18	8	23	3	17	9	10	16	12	14
无出血转化组	88	36	52	69.66±12.74	64	24	64	24	28	60	26	62	27	61
统计量		0.016^a		0.135^b	0.122^a		2.749^a		9.465^a		0.738^a		2.135^a
P值		0.899		0.893	0.727		0.097		0.002		0.390		0.144
注：^a为χ²值，^b为t值。

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表 2 2组急性大面积脑梗死患者实验室指标比较 (x ±s)

组别	例数	空腹血糖 (mmol/L)	总胆固醇 (mmol/L)	甘油三酯 (mmol/L)	高密度脂蛋白胆固醇(mmol/L)	低密度脂蛋白胆固醇(mmol/L)	脂蛋白a (mg/L)	同型半胱氨酸 (g/L)	Ca²⁺ (mmol/L)	Mg²⁺ (mmol/L)
出血转化组	26	7.56±1.99	4.29±0.96	1.07±0.48	1.27±0.33	2.41±0.70	305.65±166.08	12.37±3.87	2.07±0.10	0.81±0.11
无出血转化组	88	6.98±3.19	4.30±1.10	1.24±0.44	1.18±0.31	2.74±0.75	280.40±146.28	14.87±6.71	2.14±0.11	0.89±0.09
t值		-0.887	0.054	1.674	-1.234	2.044	-0.750	1.807	2.723	3.851
P值		0.377	0.957	0.097	0.220	0.043	0.455	0.073	0.008	< 0.001

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表 3 大面积脑梗死患者发生出血转化影响因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR(95% CI)
心房颤动	1.554	0.555	7.837	0.005	4.731(1.594~14.044)
低密度脂蛋白胆固醇	-0.795	0.420	3.580	0.058	0.451(0.198~1.029)
血钙	-2.963	2.630	1.269	0.260	0.052(0.000~8.952)
血镁	-8.143	2.952	7.610	0.006	0.000(0.000~0.095)

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