Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Eur J Neurol. 2012 Apr;19(4):570-7. doi: 10.1111/j.1468-1331.2011.03564.x. Epub 2011 Oct 15.
Because hemorrhagic transformation (HT) is associated with morbidity and mortality, we need a better understanding of the factors that predict HT after ischaemic stroke. HT is a well-known factor that limits the use of thrombolytics and it negates the effect of treatment. This study investigated whether a high serum ferritin level is associated with HT in acute ischaemic stroke.
Seven hundred and fifty-two consecutive patients with acute ischaemic stroke within 24 h after a vascular event were enrolled. HT was diagnosed using magnetic resonance imaging (MRI) or computed tomography (CT) and the HT was classified into hemorrhagic infarction (HI) type 1, 2 and parenchymal hematoma (PH) type 1, 2. HT was also classified into no HT, asymptomatic HT, minor symptomatic HT (sHT), and major sHT.
Computed tomography or MR showed HT in 90 patients (HI in 58 and PH in 32; asymptomatic in 53, minor symptomatic in 23 and major symptomatic in 14). The ferritin levels were higher in the patients who developed HT, PH and sHT. After adjustment for confounding variables, multivariate analysis showed that a high ferritin level remained an independent predictor of HT in the patients with acute ischaemic stroke (P < 0.001). Serum ferritin levels higher than 171.8 ng/ml were independently associated with sHT.
This study suggests that a high ferritin level is an important predictor of HT, PH, and sHT in patients with acute ischaemic stroke. Lowering the ferritin level with iron-modifying agents or using free radical scavengers could be helpful to prevent HT in ischaemic stroke.
由于出血性转化（HT）与发病率和死亡率相关，我们需要更好地了解预测缺血性卒中后 HT 的因素。HT 是限制溶栓剂使用的已知因素，并否定了治疗效果。本研究旨在探讨血清铁蛋白水平升高是否与急性缺血性卒中的 HT 相关。
本研究纳入了 752 例血管事件后 24 小时内发生的急性缺血性卒中患者。通过磁共振成像（MRI）或计算机断层扫描（CT）诊断 HT，并将 HT 分为出血性梗死（HI）1 型、2 型和脑实质血肿（PH）1 型、2 型。HT 还分为无 HT、无症状 HT、轻微症状性 HT（sHT）和重大症状性 HT（mHT）。
CT 或 MRI 显示 90 例患者发生 HT（HI 58 例，PH 32 例；无症状 53 例，轻微症状 23 例，重大症状 14 例）。发生 HT、PH 和 sHT 的患者铁蛋白水平较高。在调整混杂变量后，多变量分析显示，高铁蛋白水平仍然是急性缺血性卒中患者 HT 的独立预测因素（P < 0.001）。血清铁蛋白水平高于 171.8ng/ml 与 sHT 独立相关。
本研究表明，高铁蛋白水平是急性缺血性卒中患者 HT、PH 和 sHT 的重要预测因素。使用铁调节剂降低铁蛋白水平或使用自由基清除剂可能有助于预防缺血性卒中的 HT。
