摘要
目的探讨低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)与急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后出血性转化(hemorrhagic transformation,HT)的相关性。方法回顾性纳入2014年1月至2019年12月期间在山西医科大学第一医院接受标准剂量阿替普酶静脉溶栓治疗的AIS患者,在溶栓治疗后24 h内完成头颅CT检查来判定是否发生HT。比较HT组和非HT组人口统计学和基线临床资料。应用多变量logistic回归分析确定LDL-C与溶栓后HT的相关性。结果共纳入323例接受静脉溶栓治疗的AIS患者,年龄(65±12)岁(范围54~78岁),男性219例(67.8%),中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分4分(四分位数间距3~9分)。91例(28.17%)患者发生HT,其中8例(2.48%)为有症状脑出血。单变量分析显示,HT组LDL-C、年龄、基线NIHSS评分、基线收缩压和舒张压、基线纤维蛋白降解产物以及心房颤动和卒中病因学分型的患者构成比与非HT组存在显著统计学差异(P均<0.05)。多变量logistic回归分析显示,LDL-C较低[优势比(odds ratio,OR)0.531,95%置信区间(confidence interval,CI)0.358~0.788;P=0.002]、基线NIHSS评分较高(OR 1.063,95%CI 1.010~1.120;P=0.020)以及基线收缩压较高(OR 1.015,95%CI 1.004~1.026;P=0.008)为AIS患者静脉溶栓后HT的独立危险因素。结论低LDL-C是AIS患者静脉溶栓后HT的独立危险因素。对于LDL-C较低的静脉溶栓患者应谨慎降脂治疗,警惕HT发生。
Objective To investigate the correlation between low-density lipoprotein cholesterol(LDL-C)and hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods Patients with AIS received intravenous thrombolysis using standard dose alteplase in the First Hospital of Shanxi Medical University from January 2014 to December 2019 were enrolled retrospectively.Head CT scan was performed within 24 h after thrombolytic therapy to identify the occurrence of HT.The demographic and baseline clinical data were compared between the HT group and the non-HT group.Multivariate logistic regression analysis was used to determine the correlation between LDL-C and HT after thrombolysis.Results A total of 323 patients with AIS who received intravenous thrombolytic therapy were enrolled,their age was 65±12 years(range,54-78 years),and 219 were males(67.8%).The median baseline National Institutes of Health Stroke Scale(NIHSS)score was 4(interquartile range,3-9).Ninety one patients(28.17%)developed HT,of which 8(2.48%)had symptomatic intracerebral hemorrhage.Univariate analysis showed that there were significant differences in LDL-C,age,baseline NIHSS score,baseline systolic and diastolic blood pressure,baseline fibrin degradation products,and the proportion of patients with atrial fibrillation and stroke etiology between the HT group and the non-HT group(all P<0.05).Multivariate logistic regression analysis showed that lower LDL-C(odds ratio[OR]0.531,95%confidence interval[CI]0.358-0.788;P=0.002),higher baseline NIHSS score(OR 1.063,95%CI 1.010-1.120;P=0.020)and higher baseline systolic blood pressure(OR 1.015,95 CI 1.004-1.026;P=0.008)were the independent risk factors for HT after intravenous thrombolysis in patients with AIS.Conclusions Low LDL-C is an independent risk factor for HT in patients with AIS after intravenous thrombolysis.The patients with lower LDL-C should be cautious in lipid-lowering therapy and be alert to the occurrence of HT.
作者
张梦
姚阳阳
苏旖婕
仝淑敏
马联胜
Zhang Meng;Yao Yangyang;Su Yijie;Tong Shumin;Ma Liansheng(The First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,China;Department of Neurology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《国际脑血管病杂志》
2021年第3期189-193,共5页
International Journal of Cerebrovascular Diseases
关键词
卒中
脑缺血
血栓溶解疗法
脑出血
脂蛋白类
LDL
危险因素
Stroke
Brain ischemia
Thrombolytic therapy
Cerebral hemorrhage
Lipoproteins,LDL
Risk factors
