Stroke Trials Unit, Institute of Neuroscience, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham NG7 2UH, UK.
Stroke. 2010 Dec;41(12):2834-9. doi: 10.1161/STROKEAHA.109.573063. Epub 2010 Oct 28.
Asymptomatic hemorrhagic transformation of infarction (AHTI) is common, but its risk factors and relationship with functional outcome are poorly defined.
The analyses used data from the Tinzapararin in Acute Ischaemic Stroke Trial, a randomized controlled trial assessing tinzaparin (low molecular weight heparin) versus aspirin in 1484 patients with acute ischemic stroke. CT head scans (baseline, day 10) were adjudicated for the presence of hemorrhagic transformation. Stroke subtype was classified according to modified Trial of Org 10172 in Acute Stroke Treatment (small vessel, large vessel, cardioembolic) and the Oxfordshire Community Stroke Project (total anterior, partial anterior, lacunar, and posterior circulatory syndromes). Modified Rankin scale and Barthel Index were measured at 3 and 6 months. Analyses were adjusted for age, sex, severity, blood pressure, infarct volume, and treatment. Symptomatic hemorrhage was excluded.
At day 10, AHTI did not differ between aspirin (300 mg; 32.8%) and medium-dose (100 IU/kg; 36.0%) and high-dose (175 IU/kg; 31.4%) tinzaparin groups (P = 0.44). Relative to lacunar stroke, AHTI on follow-up CT was significantly increased in total anterior circulation syndrome (odds ratio, 11.5; 95% CI, 7.1 to 18.7) and partial anterior circulation syndrome (odds ratio, 7.2; 95% CI, 4.5 to 11.4) stroke. Similarly, relative to small vessel disease, AHTI was increased in large vessel (odds ratio, 15.1; 95% CI, 9.4 to 24.3) and cardioembolic (odds ratio, 14.1; 95% CI, 8.5 to 23.5) stroke. After adjustment for infarct volume, the presence of AHTI was not associated with outcome at 3 or 6 months as measured by the modified Rankin Scale and Barthel Index.
AHTI is increased in ischemic stroke with cortical syndromes and of large vessel or cardioembolic etiology. Heparin does not increase AHTI. AHTI is not associated with functional outcome.
无症状性梗死出血转化（AHTI）较为常见，但目前其危险因素及与功能结局的关系仍不明确。
本分析使用了来自 Tinzapararin 在急性缺血性卒中试验（一项评估替扎肝素（低分子肝素）与阿司匹林在 1484 例急性缺血性卒中患者中疗效的随机对照试验）的数据。对头颅 CT 扫描（基线、第 10 天）进行评估以确定有无出血转化。根据改良的 Org 10172 在急性卒中治疗试验（小血管、大血管、心源性栓塞）和牛津郡社区卒中项目（完全前循环、部分前循环、腔隙性和后循环综合征）对卒中亚型进行分类。在 3 个月和 6 个月时使用改良 Rankin 量表和巴氏指数进行测量。分析时对年龄、性别、严重程度、血压、梗死体积和治疗进行了调整。排除了症状性出血。
在第 10 天，阿司匹林（300mg；32.8%）和中剂量（100IU/kg；36.0%）及高剂量（175IU/kg；31.4%）替扎肝素组之间 AHTI 无差异（P=0.44）。与腔隙性卒中相比，完全前循环综合征（比值比，11.5；95%可信区间，7.1 至 18.7）和部分前循环综合征（比值比，7.2；95%可信区间，4.5 至 11.4）卒中患者随访 CT 上的 AHTI 显著增加。同样，与小血管疾病相比，大血管（比值比，15.1；95%可信区间，9.4 至 24.3）和心源性栓塞（比值比，14.1；95%可信区间，8.5 至 23.5）卒中患者的 AHTI 也增加。在校正梗死体积后，AHTI 的存在与 3 个月和 6 个月时的改良 Rankin 量表和巴氏指数评分的结局无关。
皮质综合征和大血管或心源性病因的缺血性卒中患者中 AHTI 增加。肝素不会增加 AHTI。AHTI 与功能结局无关。
