Lei Chunyan, Wu Bo, Liu Ming, Chen Yanchao
Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China.
Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China; State Key Laboratory of Human Disease Biotherapy and Ministry of Education, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2767-2772. doi: 10.1016/j.jstrokecerebrovasdis.2014.06.024. Epub 2014 Oct 12.
Whether asymptomatic hemorrhagic transformation (HT) is clinically innocuous, that is, unassociated with clinically detectable neurologic deterioration, remains an open question. To explore this, we examined whether asymptomatic HT affects long-term poor outcome and risk of stroke recurrence.
We consecutively and prospectively enrolled patients with acute ischemic stroke who were admitted to our hospital. Based on clinical and imaging data, patients were diagnosed as having asymptomatic HT, symptomatic HT, or not HT, and the 3 groups were compared in terms of basic clinical characteristics, poor outcome, and stroke recurrence. We constructed Kaplan-Meier survival curves and compared groups by means of log rank tests for significant difference.
Of the 1789 patients enrolled, 143 (8.0%) presented with asymptomatic HT, 25 (1.4%) presented with symptomatic HT. These patients with were more likely to be female, to have experienced atrial fibrillation, and to have higher National Institute of Health Stroke Scale score on stroke than were patients without HT. After adjusting for other confounding factors, the risk of poor outcome was significantly higher among those with asymptomatic HT and symptomatic HT than among those without HT. Moreover, patients with asymptomatic HT and symptomatic HT showed a significantly lower cumulative 1-year survival rate than did those without HT (P < .001). The patients showed similar rates of cumulative stroke recurrence at 1 year (P = .673).
Asymptomatic HT and symptomatic HT after acute ischemic stroke worsened long-term clinical outcomes, although it did not affect risk of stroke recurrence. These findings suggest that asymptomatic HT should not be considered clinically innocuous.
无症状性出血转化（HT）在临床上是否无害，即是否与临床可检测到的神经功能恶化无关，仍是一个悬而未决的问题。为了探究这一点，我们研究了无症状性HT是否会影响长期不良预后和卒中复发风险。
我们连续前瞻性纳入了我院收治的急性缺血性卒中患者。根据临床和影像学资料，将患者诊断为无症状性HT、症状性HT或无HT，并比较三组患者的基本临床特征、不良预后和卒中复发情况。我们构建了Kaplan-Meier生存曲线，并通过对数秩检验比较组间差异是否具有统计学意义。
在纳入的1789例患者中，143例（8.0%）出现无症状性HT，25例（1.4%）出现症状性HT。与无HT的患者相比，这些患者更可能为女性、有房颤病史，且卒中时美国国立卫生研究院卒中量表评分更高。在调整其他混杂因素后，无症状性HT和症状性HT患者的不良预后风险显著高于无HT的患者。此外，无症状性HT和症状性HT患者的1年累积生存率显著低于无HT的患者（P <.001）。患者1年时的累积卒中复发率相似（P = 0.673）。
急性缺血性卒中后的无症状性HT和症状性HT会使长期临床预后恶化，尽管不影响卒中复发风险。这些发现表明，无症状性HT在临床上不应被视为无害。
