预防性使用抗栓药物对急性脑梗死后出血转化的影响
|
摘要
目的:探讨脑梗死发病前使用抗栓药物治疗对急性脑梗死后出血转化的影响。方法:选取2005-05-2015-05在我院神经内科住院的急性脑梗死患者为研究对象,根据我院脑梗死登记库中信息收集所有这些患者的全部资料,包括入院时的基本资料,既往的治疗史(主要是抗凝药物以及抗血小板聚集药物的具体使用情况)和头部CT/MRI以及脑血管等影像学资料。根据入院后48h的头部CT/MRI的结果,将出血转化患者纳入到出血转化组,从非出血转化患者中选取和出血转化组数量、性别、年龄非常匹配的患者纳入为非出血转化组。对比2组患者的用药情况和基线情况,对2组间有差异的危险因素进行多因素Logistic回归分析,研究脑梗死发病前使用抗栓药物治疗与急性脑梗死后出血转化的关系。结果:共纳入7 524例急性脑梗死患者,其中489例(6.5%)纳入出血转化组,性别、年龄和病程均与出血转化组匹配的未出血转化组患者也纳入489例(6.5%)。2组患者入院时美国国立卫生研究院脑卒中量表(NIHSS)评分、既往脑梗死病史以及心房颤动比较差异有着显著统计学意义(均P<0.05)。出血转化组病前使用抗拴药物的比例均显著高于非出血转化组(P<0.05)。多因素Logistic回归分析结果表明,入院时的NIHSS评分、心房颤动、既往脑梗死病史以及抗栓药物的使用均为出血转化的独立危险因素(P<0.05)。结论:脑梗死发病前使用抗栓药物治疗与急性脑梗死后出血转化独立相关,其与急性脑梗死预后的疗效关系还有待进一步的探讨。
Objective:To investigate the effect of prophylactic antithrombotic drugs on hemorrhagic transformation after acute cerebral infarction.Method:Patients with infarction admitted to the department of neurology from may 2005 to may 2015 in our hospital.The baseline data on admission,previous usage of anticoagulants and anti-platelet aggregation drugs,as well as CT/MRI and other imaging data of all patients were collected.According to the results of CT/MRI reexamined at 48 h after admission,the patients with hemorrhagic transformation were enrolled into a hemorrhagic transformation group;the patients with nonhemorrhagic transformation were enrolled into a non-hemorrhagic transformation group according to the same number of hemorrhagic transformation group.Their course of disease,gender and age were matched with the hemorrhagic transformation group.The baseline data and drug used of the patients in both groups were compared.The differences of risk factors between the two groups were analyzed with multivariate Logistic regression analysis.The relationship between hemorrhagic transformation and premorbid use of antithrombotic drugs were observed.Result:A total of 7 524 patients with acute cerebral infarction were enrolled,including 489(6.5%)hemorrhagic transformation(hemorrhagic transformation group)and 489(6.5%)non-hemorrhagic transformation.There were significant differences between the patients of the two groups on admission in the National Institutes of Health Stroke Scale(NIHSS)score,atrial fibrillation and previous cerebral infarction(all P<0.05).The proportions of using antithrombotics in the hemorrhagic transformation group were higher than those of the non-hemorrhagic transformation group.The results of multivariate Logistic regression analysis showed that the NIHSS score on admission,atrial fibrillation,previous cerebral infarction and use of antithrombotics were the independent risk factors for hemorrhagic transformation.Conclusion:Using anticoagulants or anti-platelet aggregation drugs before symptom onset is independently associated with hemorrhagic transformation,however,its relationship with the long-term prognosis of acute cerebral infarction need to be further studied.
Objective:To investigate the effect of prophylactic antithrombotic drugs on hemorrhagic transformation after acute cerebral infarction.Method:Patients with infarction admitted to the department of neurology from may 2005 to may 2015 in our hospital.The baseline data on admission,previous usage of anticoagulants and anti-platelet aggregation drugs,as well as CT/MRI and other imaging data of all patients were collected.According to the results of CT/MRI reexamined at 48 h after admission,the patients with hemorrhagic transformation were enrolled into a hemorrhagic transformation group;the patients with nonhemorrhagic transformation were enrolled into a non-hemorrhagic transformation group according to the same number of hemorrhagic transformation group.Their course of disease,gender and age were matched with the hemorrhagic transformation group.The baseline data and drug used of the patients in both groups were compared.The differences of risk factors between the two groups were analyzed with multivariate Logistic regression analysis.The relationship between hemorrhagic transformation and premorbid use of antithrombotic drugs were observed.Result:A total of 7 524 patients with acute cerebral infarction were enrolled,including 489(6.5%)hemorrhagic transformation(hemorrhagic transformation group)and 489(6.5%)non-hemorrhagic transformation.There were significant differences between the patients of the two groups on admission in the National Institutes of Health Stroke Scale(NIHSS)score,atrial fibrillation and previous cerebral infarction(all P<0.05).The proportions of using antithrombotics in the hemorrhagic transformation group were higher than those of the non-hemorrhagic transformation group.The results of multivariate Logistic regression analysis showed that the NIHSS score on admission,atrial fibrillation,previous cerebral infarction and use of antithrombotics were the independent risk factors for hemorrhagic transformation.Conclusion:Using anticoagulants or anti-platelet aggregation drugs before symptom onset is independently associated with hemorrhagic transformation,however,its relationship with the long-term prognosis of acute cerebral infarction need to be further studied.
引文
[1]Sussman E S,Connolly E S Jr.Hemorrhagic transformation:a review of the rate of hemorrhage in the major clinical trials of acute ischemic stroke[J].Front Neurol,2013,4(69):1-7.
[2]刘顶成,吕传柱,王伟锋,等.院前急救与急诊介入一体化治疗急性脑梗死的临床研究[J].临床急诊杂志,2011,6(12):155-157.
[3]刘安捷,杨帆,白祥军.创伤性脑梗死相关危险因素研究[J].临床急诊杂志,2015,16(7):501-506.
[4]熊莉君,张临洪.急性脑梗死出血转化危险因素研究[J].中国全科医学,2014,17(15):1707-1709,1722.
[5]周义翰,施建曦,顾凌.超敏C-反应蛋白与缺血性脑血管病危险相关性研究[J].临床急诊杂志,2012,13(1):41-42,45.
[6]屠建莹,张京,张于刚.溶栓治疗对脑梗死患者近期及远期康复预后的影响[J].中国康复理论与实践,2015,21(7):816-820.
[7]陈艳超,雷春艳,刘鸣.急性脑梗死后出血转化与病前抗栓治疗的相关性研究[J].中国脑血管病杂志,2015,12(4):174-179.
[8]Alvarez-Sabín J,Maisterra O,Santamarina E,et al.Factors influencing haemorrhagic transformation in ischaemic stroke[J].Lancet Neurol,2013,12(7):689-705.
[9]李东瑞,杨伟民,苏楠,等.脑梗死后出血转化危险因素分析[J].中国实用神经疾病杂志,2013,16(10):102-104.
[10]Kernan W N,Ovbiagele B,Black H R,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:aguideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160-2236.
[11]陈钊,蔡国庆,邱宇,等.复发性脑梗死的二级预防现况调查[J].当代医学,2013,19(15):6-9.
[12]Saposnik G,Gladstone D,Raptis R,et al.Atrial fibrillation in ischemic stroke predicting response to thrombolysis and clinnical outcomes[J].Stroke,2013,44(1):99-104.
[13]谭戈,刘鸣,雷春燕,等.急性脑梗死后非溶栓患者出血转化的影响因素分析[J].中国脑血管病杂志,2015,12(8):409-414.
[14]刘振兴,白祥琰,桂峰,等.氯吡格雷联合阿司匹林治疗短暂性脑缺血发作的系统评价[J].临床急诊杂志,2014,15(9):538-544.
[15]Meurer W J,Kwok H,Skolarus L E,et al.Does preexisting antiplatelet treatment influence postthrombolysis intracranial hemorrhage in community-treated ischemic stroke patients?An observational study[J].Acad Emerg Med,2013,20(2):146-154.
[16]高志强,张鹏,戴瑛.联合抗栓治疗急性缺血性脑卒中的近期疗效和安全性[J].南京医科大学学报,2015,35(8):1152-1154.
[2]刘顶成,吕传柱,王伟锋,等.院前急救与急诊介入一体化治疗急性脑梗死的临床研究[J].临床急诊杂志,2011,6(12):155-157.
[3]刘安捷,杨帆,白祥军.创伤性脑梗死相关危险因素研究[J].临床急诊杂志,2015,16(7):501-506.
[4]熊莉君,张临洪.急性脑梗死出血转化危险因素研究[J].中国全科医学,2014,17(15):1707-1709,1722.
[5]周义翰,施建曦,顾凌.超敏C-反应蛋白与缺血性脑血管病危险相关性研究[J].临床急诊杂志,2012,13(1):41-42,45.
[6]屠建莹,张京,张于刚.溶栓治疗对脑梗死患者近期及远期康复预后的影响[J].中国康复理论与实践,2015,21(7):816-820.
[7]陈艳超,雷春艳,刘鸣.急性脑梗死后出血转化与病前抗栓治疗的相关性研究[J].中国脑血管病杂志,2015,12(4):174-179.
[8]Alvarez-Sabín J,Maisterra O,Santamarina E,et al.Factors influencing haemorrhagic transformation in ischaemic stroke[J].Lancet Neurol,2013,12(7):689-705.
[9]李东瑞,杨伟民,苏楠,等.脑梗死后出血转化危险因素分析[J].中国实用神经疾病杂志,2013,16(10):102-104.
[10]Kernan W N,Ovbiagele B,Black H R,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:aguideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160-2236.
[11]陈钊,蔡国庆,邱宇,等.复发性脑梗死的二级预防现况调查[J].当代医学,2013,19(15):6-9.
[12]Saposnik G,Gladstone D,Raptis R,et al.Atrial fibrillation in ischemic stroke predicting response to thrombolysis and clinnical outcomes[J].Stroke,2013,44(1):99-104.
[13]谭戈,刘鸣,雷春燕,等.急性脑梗死后非溶栓患者出血转化的影响因素分析[J].中国脑血管病杂志,2015,12(8):409-414.
[14]刘振兴,白祥琰,桂峰,等.氯吡格雷联合阿司匹林治疗短暂性脑缺血发作的系统评价[J].临床急诊杂志,2014,15(9):538-544.
[15]Meurer W J,Kwok H,Skolarus L E,et al.Does preexisting antiplatelet treatment influence postthrombolysis intracranial hemorrhage in community-treated ischemic stroke patients?An observational study[J].Acad Emerg Med,2013,20(2):146-154.
[16]高志强,张鹏,戴瑛.联合抗栓治疗急性缺血性脑卒中的近期疗效和安全性[J].南京医科大学学报,2015,35(8):1152-1154.