摘要目的 探讨急性脑梗死降纤治疗出血性转化的危险因素. 方法 对南通市通州区人民医院神经内科自2011年3月至2015年5月采用巴曲酶降纤治疗的245例急性脑梗死患者的临床资料进行回顾性分析.根据住院期间头颅CT或MRI复查结果分为出血组18例,非出血组227例.对可能影响降纤治疗出血性转化的危险因素进行Logistic回归分析.对校正后的独立危险因素进行受试者工作特征(ROC)曲线分析以获得预测降纤治疗出血性转化的最佳界值. 结果 单因素分析显示,2组患者美国国立卫生研究院卒中量表(NIHSS)评分、心源性脑栓塞、大面积脑梗死、皮层梗死、空腹血糖比较差异有统计学意义(P＜0.05).Logistic回归分析显示,NIHSS评分(OR=1.262,95％ CI=1.025～1.554,P=0.028)、心源性脑栓塞(OR=3.949,95％ CI=1.093～14.269,p=0.036)是急性脑梗死降纤治疗出血性转化的独立危险因素.ROC曲线分析显示,NIHSS评分预测降纤治疗出血性转化的最佳界值为14分. 结论 NIHSS评分高、心源性脑栓塞是急性脑梗死降纤治疗出血性转化的独立危险因素.

abstractsObjective To explore the risk factors of hemorrhagic transformation (HT) following defibrase therapy in patients with acute cerebral infarction.Methods The clinical data of 245 patients with acute cerebral infarction,admitted to and treated with batroxobin in our hospital from March 2011 to May 2015,were summarized retrospectively.According to the intracranial hemorrhage under hospital CT scan or MRI,these patients were divided into HT group (n=18) and non-HT group (n=227).Influencing factors were analyzed by stepwise Logistic regression.The receiver operating characteristic (ROC) curve analysis on the independent risk factors was performed to obtain the optimum predictive value of HT following defibrase therapy.Results National Institutes of Health Stroke Scale (NIHSS) scores,sizes of cardioembolism,massive hemispheric infarction and cortical infarction,and fasting blood glucose level were statistically significant between HT and non-HT groups (P＜0.05).Logistic regression analysis demonstrated that NIHSS scores (OR=1.262,95％ CI=1.025-1.554,P=0.028) and size of cardioembolism (OR=3.949,95％CI=1.093-14.269,P=0.036) were independent predictors of HT following defibrase therapy in patients with acute cerebral infarction.The ROC curve showed that the optimal cutoffpoint of NIHSS scores to predict HT was 14.Conclusion Risk factors associated with HT following defibrase therapy in patients with acute cerebral infarction include high NIHSS scores and cardioembolism.