Öcek Levent, Güner Derya, Uludağ İrem Fatma, Tiftikçioğlu Bedile İrem, Zorlu Yaşar
Clinic of Neurology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey.
Noro Psikiyatr Ars. 2015 Dec;52(4):342-345. doi: 10.5152/npa.2015.8792. Epub 2015 Dec 1.
Hemorrhagic transformation (HT) after acute ischemic stroke (AIS) can be seen at any time following ischemic stroke. Although HT usually occurs as a complication of antithrombotic, anticoagulant, or thrombolytic treatments, it can also occur spontaneously. We aimed to investigate the occurrence of early HT and its relevant risk factors in patients diagnosed with acute middle cerebral artery (MCA) infarction who were not treated with thrombolytic agents.
We recruited 171 patients with acute MCA infarction between January 2011 and July 2012 who were not treated with thrombolytic agents and were suitable to our inclusion criteria. Controlled neuroimaging was performed immediately in patients with deterioration, otherwise on day 7 following stroke. All patients were investigated for AIS risk factors and biochemical analyses were performed. Patients with HT in controlled neuroimaging were grouped both clinically (i.e., symptomatic or asymptomatic) and radiologically, according to "European Cooperative Acute Stroke Radiological Study" (ECASS), and risk factors were examined.
We enrolled 171 patients [94 men (55%) and 77 women (45%)] in the study. HT developed in 37 patients (21.63%). In terms of risk factor analysis, the most frequent etiological factor was atherosclerosis in AIS patients (50.3%). National Institutes of Health Stroke Scale scores were significantly higher both in sHT patients according to asHT patients and in HT patients on day 7 compared with their initial scores. Serum low-density lipoprotein (LDL-C), triglycerides (TG), and total cholesterol (TC) levels were significantly lower in patients with HT (p<.001).
HT is a major complication in AIS that considerably increases the morbidity and mortality. To reduce the occurrence of HT, risk factors for each patient population should be determined. Acute thrombolytic therapy should be used cautiously in high-risk patients, and appropriate alternative therapies should be revised in them.
急性缺血性卒中（AIS）后的出血性转化（HT）可在缺血性卒中后的任何时间出现。虽然HT通常作为抗栓、抗凝或溶栓治疗的并发症出现，但也可能自发发生。我们旨在调查未接受溶栓治疗的急性大脑中动脉（MCA）梗死患者早期HT的发生率及其相关危险因素。
我们招募了2011年1月至2012年7月期间未接受溶栓治疗且符合纳入标准的171例急性MCA梗死患者。病情恶化的患者立即进行对照神经影像学检查，否则在卒中后第7天进行。对所有患者进行AIS危险因素调查并进行生化分析。对照神经影像学检查发现有HT的患者，根据“欧洲急性卒中合作放射学研究”（ECASS）进行临床（即有症状或无症状）和放射学分组，并检查危险因素。
我们纳入了171例患者[94例男性（55%）和77例女性（45%）]进行研究。37例患者（21.63%）发生了HT。在危险因素分析方面，AIS患者中最常见的病因是动脉粥样硬化（50.3%）。与无症状HT患者相比，有症状HT患者以及第7天的HT患者的美国国立卫生研究院卒中量表评分均显著高于其初始评分。HT患者的血清低密度脂蛋白（LDL-C）、甘油三酯（TG）和总胆固醇（TC）水平显著较低（p<0.001）。
HT是AIS的主要并发症，会显著增加发病率和死亡率。为降低HT的发生率，应确定每个患者群体的危险因素。高危患者应谨慎使用急性溶栓治疗，并应为他们修订合适的替代治疗方法。
