广泛的脑微出血可预测静脉溶栓后实质出血和不良预后。
Extensive cerebral microbleeds predict parenchymal haemorrhage and poor outcome after intravenous thrombolysis.
机构信息
Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
University of California-Los Angeles Stroke Center, Los Angeles, California, USA.
出版信息
J Neurol Neurosurg Psychiatry. 2015 Nov;86(11):1267-72. doi: 10.1136/jnnp-2014-309857. Epub 2015 Jan 28.
PURPOSE
Thrombolysis-related haemorrhagic transformation (HT) subtypes may have different prognostic implications. We aimed to analyse the impact of cerebral microbleeds (CMBs) burden on HT subtypes and outcome after intravenous thrombolysis.
METHODS
We retrospectively examined clinical and radiological data from 333 consecutive patients with acute ischaemic stroke who underwent susceptibility-weighted imaging before intravenous thrombolysis. Logistic regression analysis was used to determine the impact of CMBs on HT subtypes and neurological outcome.
RESULTS
We observed 596 CMBs in 119 (39.7%) patients on initial gradient-recalled echo scans. HT occurred in 88 (29.3%) patients, among which 62 were haemorrhagic infarction and 26 were parenchymal haemorrhage (PH). Logistic regression analysis indicated that the presence of extensive (≥ 3) CMBs was independently associated with PH (OR 6.704; 95% CI 2.054 to 21.883; p = 0.002) and poor clinical outcome (OR 2.281; 95% CI 1.022 to 5.093; p = 0.044).
CONCLUSIONS
The presence of extensive (≥ 3) CMBs increased the risk of PH 24 h after intravenous thrombolysis, and predicted poor clinical outcome independently.
目的
溶栓相关的出血性转化（HT）亚型可能具有不同的预后意义。我们旨在分析脑微出血（CMB）负担对静脉溶栓后 HT 亚型和结局的影响。
方法
我们回顾性分析了 333 例接受静脉溶栓前磁敏感加权成像的急性缺血性脑卒中连续患者的临床和影像学数据。使用逻辑回归分析确定 CMBs 对 HT 亚型和神经结局的影响。
结果
我们在初始梯度回波扫描中观察到 119 例（39.7%）患者存在 596 个 CMB。88 例患者发生 HT，其中 62 例为出血性梗死，26 例为脑实质出血（PH）。逻辑回归分析表明，广泛（≥3）CMBs 的存在与 PH（OR 6.704；95%CI 2.054 至 21.883；p=0.002）和不良临床结局（OR 2.281；95%CI 1.022 至 5.093；p=0.044）独立相关。
结论
静脉溶栓后 24 小时广泛（≥3）CMBs 的存在增加了 PH 的风险，且独立预测了不良的临床结局。
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