脑微出血是急性缺血性卒中静脉注射阿替普酶后出血转化的独立预测因素。
Cerebral Microbleeds are an Independent Predictor of Hemorrhagic Transformation Following Intravenous Alteplase Administration in Acute Ischemic Stroke.
作者信息
Nagaraja Nandakumar, Tasneem Nudrat, Shaban Amir, Dandapat Sudeepta, Ahmed Uzair, Policeni Bruno, Olalde Heena, Shim Hyungsub, Samaniego Edgar A, Pieper Connie, Ortega-Gutierrez Santiago, Leira Enrique C, Adams Harold P
机构信息
Department of Neurology, University of Florida College of Medicine, Gainesville, Florida; Department of Neurology, Carver College of Medicine, University of Iowa, Iowa.
Department of Neurology, Carver College of Medicine, University of Iowa, Iowa.
出版信息
J Stroke Cerebrovasc Dis. 2018 May;27(5):1403-1411. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.044. Epub 2018 Feb 3.
BACKGROUND AND PURPOSE
Intravenous alteplase (rt-PA) increases the risk of hemorrhagic transformation of acute ischemic stroke. The objective of our study was to evaluate clinical, laboratory, and imaging predictors on forecasting the risk of hemorrhagic transformation following treatment with rt-PA. We also evaluated the factors associated with cerebral microbleeds that increase the risk of hemorrhagic transformation.
METHODS
Consecutive patients with acute ischemic stroke admitted between January 1, 2009 and December 31, 2013 were included in the study if they received IV rt-PA, had magnetic resonance imaging (MRI) of the brain on admission, and computed tomography or MRI of the brain at 24 (18-36) hours later to evaluate for the presence of hemorrhagic transformation. The clinical data, lipid levels, platelet count, MRI, and computed tomography images were retrospectively reviewed.
RESULTS
The study included 366 patients, with mean age 67 ± 15 years; 46% were women and 88% were white. The median National Institutes of Health Stroke Scale (NIHSS) score was 6 (interquartile range 3-15). Hemorrhagic transformation was observed in 87 (23.8%) patients and cerebral microbleeds were noted in 95 (25.9%). Patients with hemorrhagic transformation tended to be older, nonwhite, have atrial fibrillation, higher baseline NIHSS score, lower cholesterol and triglyceride levels, and cerebral microbleeds and nonlacunar infarcts. Patients with cerebral microbleeds were more likely to be older, have hypertension, hyperlipidemia, previous history of stroke, and prior use of antithrombotics. On multivariate analysis race, NIHSS score, nonlacunar infarct, and presence of cerebral microbleeds were independently associated with hemorrhagic transformation following treatment with rt-PA.
CONCLUSIONS
Presence of cerebral microbleeds is an independent predictor of hemorrhagic transformation of acute ischemic stroke following treatment with rt-PA.
背景与目的
静脉注射阿替普酶（rt-PA）会增加急性缺血性卒中发生出血性转化的风险。我们研究的目的是评估临床、实验室及影像学指标对预测rt-PA治疗后出血性转化风险的作用。我们还评估了与增加出血性转化风险的脑微出血相关的因素。
方法
纳入2009年1月1日至2013年12月31日期间连续收治的急性缺血性卒中患者，这些患者接受了静脉rt-PA治疗，入院时进行了脑部磁共振成像（MRI）检查，并在24（18 - 36）小时后进行了脑部计算机断层扫描（CT）或MRI检查以评估是否存在出血性转化。对临床数据、血脂水平、血小板计数、MRI及CT图像进行回顾性分析。
结果
该研究纳入了366例患者，平均年龄67±15岁；46%为女性，88%为白人。美国国立卫生研究院卒中量表（NIHSS）评分中位数为6（四分位间距3 - 15）。87例（23.8%）患者出现出血性转化，95例（25.9%）发现脑微出血。发生出血性转化的患者往往年龄较大、非白人、患有房颤、基线NIHSS评分较高、胆固醇和甘油三酯水平较低，且存在脑微出血和非腔隙性梗死。有脑微出血的患者更可能年龄较大、患有高血压、高脂血症、有卒中病史及既往使用过抗栓药物。多因素分析显示，种族、NIHSS评分、非腔隙性梗死及脑微出血的存在与rt-PA治疗后出血性转化独立相关。
结论
脑微出血的存在是rt-PA治疗后急性缺血性卒中出血性转化的独立预测因素。
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