Kellert L, Herweh C, Sykora M, Gussmann P, Martin E, Ringleb P A, Steiner T, Bösel J
Department of Neurology, University of Heidelberg, Heidelberg, Germany.
Cerebrovasc Dis Extra. 2012 Oct 27;2(1):99-107. doi: 10.1159/000343731. Print 2012 Jan.
The association of mortality and poor outcome with reduced levels of hemoglobin (Hb) and hematocrit (Hct) in patients admitted for ischemic stroke was recently demonstrated. The mechanisms behind this have remained unclear.
Here, we aimed to investigate a putative association between low Hb and Hct levels and infarct growth.
All consecutive patients who received intravenous thrombolysis based on multimodal magnetic resonance imaging during the years 1998-2009 were screened. Laboratory data as well as admission magnetic resonance images and follow-up computed tomography scans of 257 patients were assessed. Overall, data of 100 patients were of sufficient quality and further analyzed.
Decrease in Hb and Hct as well as perfusion-weighted imaging volume, mismatch volume, and final infarct size on follow-up computed tomography were associated with infarct growth. A linear regression model revealed Hb decrease (β = 0.23, p = 0.02) to be a predictor of infarct growth, independent of mismatch volume (β = 0.27, p = 0.004) and minimum sodium (β = -0.21, p = 0.03), and adjusted to the non-predicting variables age, National Institute of Health Stroke Scale score, maximum leucocytes and C-reactive protein, blood glucose, and Hct decrease.
Hb levels that decrease after admission independently predict infarct growth in thrombolyzed stroke patients. The clinical implications of this relationship remain to be investigated.
近期研究表明，缺血性中风患者入院时血红蛋白（Hb）和血细胞比容（Hct）水平降低与死亡率及不良预后相关。但其背后机制尚不清楚。
在此，我们旨在研究低Hb和Hct水平与梗死灶扩大之间的假定关联。
对1998年至2009年间所有接受基于多模态磁共振成像的静脉溶栓治疗的连续患者进行筛查。评估了257例患者的实验室数据以及入院时的磁共振图像和随访计算机断层扫描。总体而言，100例患者的数据质量足够并进行了进一步分析。
随访计算机断层扫描显示，Hb和Hct的降低以及灌注加权成像体积、不匹配体积和最终梗死灶大小与梗死灶扩大相关。线性回归模型显示，Hb降低（β = 0.23，p = 0.02）是梗死灶扩大的预测因素，独立于不匹配体积（β = 0.27，p = 0.004）和最低钠水平（β = -0.21，p = 0.03），并针对非预测变量年龄、美国国立卫生研究院卒中量表评分、最高白细胞计数和C反应蛋白、血糖以及Hct降低进行了调整。
入院后降低的Hb水平独立预测溶栓治疗的中风患者梗死灶扩大。这种关系的临床意义仍有待研究。
