急性脑梗死溶栓治疗后脑微出血的影响因素分析

Analysis of Influencing Factors of Cerebral Microhemorrhage after Thrombolytic Ther-apy for Acute Cerebral Infarction

摘要: 目的：分析急性脑梗死溶栓治疗后合并脑微出血的可能影响因素。方法：入选2018年1月至2022年3月于延安大学咸阳医院因急性脑梗死发病而入院患者165例，经过阿替普酶溶栓治疗后，根据患者影像学是否合并脑微出血，将患者分为无脑微出血组(73例)和脑微出血组(92例)。比较两组患者的年龄、性别、发病至溶栓治疗时间、是否合并高血压、是否合并糖尿病、是否合并心房颤动、入院NIHSS评分、改良Rankin评分、GlasgGow评分、出院NIHSS评分、同型半胱氨酸(Hcy)水平、脂蛋白相关磷脂酶A2 (Lp-PLA2)水平、总胆固醇(TG)水平、甘油三酯(TC)水平、高密度脂蛋白(HDL)水平、低密度脂蛋白(LDL)水平，探讨急性脑梗死溶栓治疗后患者合并脑微出血的可能影响因素。采用单因素及多因素Logistic回归分析影响急性脑梗死溶栓治疗患者发生脑微出血的可能因素，并制定相应的风险预测模型。结果：合并高血压(OR = 3.191, P = 0.002)、合并糖尿病(OR = 2.516, P = 0.025)、高Lp-PLA2水平(OR = 1.004, P = 0.039)是急性脑梗死溶栓治疗后发生脑微出血的独立危险因素。合并心房颤动(OR = 0.185, P = 0.029)、高LDL水平(OR = 0.630, P = 0.025)是急性脑梗死溶栓治疗后发生脑微出血的独立保护因素。根据OR值并制定风险预测模型，Lp-PLA2水平 ≥ 198.5 ng/mL的患者为急性脑梗死溶栓治疗后合并脑微出血的高风险人群，灵敏度为77.2%，特异度为61.6%。结论：在急性脑梗死溶栓治疗后，对既往有高血压史、糖尿病史及高Lp-PLA2水平者应密切关注，以预防脑微出血，改善患者预后。

Abstract: Objective: To analyze the possible influencing factors of cerebral microbleeds after thrombolytic therapy for acute cerebral infarction. Methods: A total of 165 patients admitted to the Xianyang Hospital of Yan’an University for acute cerebral infarction from January 2018 to March 2022 were enrolled. After alteplase thrombolytic therapy, the patients were divided into two groups: one is non-cerebral microbleeds group (73 cases) and the other is cerebral microbleeds group (92 cases), according to whether the patients had cerebral microbleeds on imaging tests. Age, sex, time from onset to thrombolytic therapy, hypertension, diabetes, atrial fibrillation, NIHSS score at admission, modified Rankin score, GlasgGow score, NIHSS score at discharge, homocysteine (Hcy) level, Lipo-protein-associated phospholipaseA2 (Lp-PLA2) level, total cholesterol (TG) level, triglyceride (TC) level, high density lipoprotein (HDL) level, low density lipoprotein (LDL) level were compared be-tween the two groups. To investigate the possible influencing factors of cerebral microbleeds in pa-tients after thrombolytic therapy for acute cerebral infarction, univariate and multivariate Logistic regression analysis were used to analyze the possible factors affecting the occurrence of cerebral microbleeds in patients after thrombolytic therapy for acute cerebral infarction, and the corre-sponding risk prediction model was developed. Results: Hypertension (OR = 3.191, P = 0.002), dia-betes (OR = 2.516, P = 0.025) and high Lp-PLA2 level (OR = 1.004, P = 0.039) were independent risk factors for cerebral microbleeds after thrombolytic therapy for acute cerebral infarction. Atrial fi-brillation (OR = 0.185, P = 0.029) and high LDL level (OR = 0.630, P = 0.025) were independent protective factors for cerebral microbleeds after thrombolytic therapy for acute cerebral infarction. According to the OR value and the risk prediction model, patients with hematalLp-PLA2 level ≥ 198.5 ng/mL were at high risk of cerebral microbleeds after thrombolysis for acute cerebral infarc-tion. The sensitivity and specificity were respectively at 77.2% and 61.6%. Conclusion: After thrombolysis therapy for acute cerebral infarction, special attention should be paid to patients with a history of hypertension, diabetes and high hematal Lp-PLA2 level to prevent cerebral microbleeds and improve the prognosis of patients.