刘明苏 汤也 付庆

[摘要]目的 分析急性脑梗死非溶栓患者出血转化的影响因素。方法 回顾性分析2017年1月～2018年12月于我院住院的802例急性脑梗死非溶栓患者的临床资料，按照是否发生出血转化将其分为出血转化组（35例）和非出血转化组（767例）。比较两組的相关因素，后将差异有统计学的因素进一步纳入多因素Logistic回归分析。结果 单因素分析结果显示，两组患者的年龄、高血压病史、房颤、冠心病、心脏病、卒中类型、大面积脑梗死、美国国立卫生研究院卒中量表（NIHSS）评分、抗血小板药物、清蛋白水平比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，高NIHSS评分、大面积脑梗死及低清蛋白水平均是出血转化发生的独立危险因素，高血压病史是独立保护因素（P<0.05）。结论 低清蛋白水平、大面积脑梗死、高NIHSS评分是急性脑梗死非溶栓患者出血转化的独立危险因素，高血压是其独立保护因素，这为临床决策上的制定提供了极大帮助，但仍需大样本的创新研究来进一步证实此结论。

[关键词]清蛋白;出血转化;急性脑梗死;非溶栓患者

[中图分类号] R743          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0016-05

[Abstract] Objective To analyze the influencing factors of hemorrhage transformation in acute ischemic stroke patients without thrombolytic therapy. Methods Retrospective analysis was performed in the clinical data of 802 acute ischemic stroke patients without thrombolytic therapy from January 2017 to December 2018 in our hospital， and they were divided into hemorrhage transformation group （35 cases） and non-hemorrhage transformation group （767 cases） according to whether hemorrhage transformation occurred or not. The related factors of the two groups were compared， and the factors with statistical differences were further included in the multivariate Logistic regression analysis. Results Univariate analysis results showed that there were statistically significant differences in age， history of hypertension， atrial fibrillation， coronary heart disease， heart disease， stroke type， large-area ischemic stroke， national institutes of health stroke scale （NIHSS） score， antiplatelet drugs， and albumin level between the two groups （P<0.05）. Multivariate Logistic regression analysis showed that high NIHSS score， large-area ischemic stroke and low albumin level were independent risk factors for hemorrhagic transformation， and history of hypertension was an independent protective factor for hemorrhagic transformation （P<0.05）. Conclusion Low albumin level， high NIHSS score， large-area ischemic stroke are independently risk factors for hemorrhagic transformation of acute ischemic stroke patients without thrombolytic therapy and hypertension is an independently protective factor， which has provided great help in clinical decision-making， but large sample of innovative researches are still needed to further confirm this conclusion.

[Key words] Albumin; Hemorrhagic transformation; Acute ischemic stroke; Without thrombolytic therapy

随着全球老龄化的到来，脑卒中成为了人类健康的一大杀手，有较高的发病率、致残率、致死率[1]。缺血性脑梗死是脑卒中最常见的亚型，其致命性并发症是出血转化，是指在急性梗死灶或周边相关血管分布区域里发生的出血[2]。随着静脉内溶栓、血管内治疗（局部溶栓、取栓、吸栓、支架等）的广泛应用和医学影像的飞速发展，出血轉化的发生率逐渐升高[3]。……