Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
J Investig Med. 2019 Mar;67(3):659-662. doi: 10.1136/jim-2018-000827. Epub 2018 Oct 26.
Intravenous thrombolysis with the tissue plasminogen activator (tPA) is the gold standard for acute ischemic stroke. However, its application is limited because of the concern of the post-tPA intracranial hemorrhage (ICH). Low low-density lipoprotein (LDL) has been speculated to increase the risk of hemorrhagic transformation after ischemic stroke. However, whether LDL is associated with post-tPA ICH remains controversial. The present study obtained the medical records from Shuang Ho Hospital and retrospectively reviewed for the period between August 2009 and December 2016 to investigate the association between LDL and the risk of post-tPA ICH. The differences were analyzed using the Student's t-test, Fisher's exact test, the univariate and stepwise multiple regression model, and p<0.05 was considered statistically significant. Among 218 patients, post-tPA ICH was noted in 23 (10.5%) patients. Patients with post-tPA ICH tended to have a lower LDL level (ICH group: 102.00±24.56, non-ICH group: 117.02±37.60 mg/dL, p=0.063). However, after adjustment for the factors might affect the risk of post-tPA ICH, such as stroke severity, onset-to-treatment time interval, and atrial fibrillation (AF), LDL level was not associated with post-tPA ICH whereas AF was the only significant factor increased the risk of post-tPA ICH (adjusted OR: 1.177, 95% CI 1.080 to 1.283). In addition, patients with AF had significant lower LDL level and for patients without AF, LDL was not associated with the post-tPA ICH. In conclusion, LDL level is not associated with the risk of post-tPA ICH in Taiwanese patients with stroke.
静脉溶栓治疗采用组织型纤溶酶原激活物（tPA）是急性缺血性脑卒中的金标准。然而，由于担心 tPA 后颅内出血（ICH），其应用受到限制。低低密度脂蛋白（LDL）被推测会增加缺血性脑卒中后出血转化的风险。然而，LDL 是否与 tPA 后 ICH 相关仍存在争议。本研究从双和医院获取病历，并对 2009 年 8 月至 2016 年 12 月期间进行回顾性研究，以调查 LDL 与 tPA 后 ICH 风险之间的关系。采用 Student's t 检验、Fisher 确切检验、单变量和逐步多元回归模型分析差异，p<0.05 为统计学显著差异。在 218 例患者中，23 例（10.5%）患者出现 tPA 后 ICH。发生 tPA 后 ICH 的患者 LDL 水平较低（ICH 组：102.00±24.56，非 ICH 组：117.02±37.60mg/dL，p=0.063）。然而，在校正可能影响 tPA 后 ICH 风险的因素（如脑卒中严重程度、发病至治疗时间间隔和心房颤动（AF））后，LDL 水平与 tPA 后 ICH 无关，而 AF 是唯一增加 tPA 后 ICH 风险的显著因素（调整后的 OR：1.177，95%CI 1.080 至 1.283）。此外，患有 AF 的患者 LDL 水平显著较低，而对于没有 AF 的患者，LDL 与 tPA 后 ICH 无关。总之，LDL 水平与台湾脑卒中患者 tPA 后 ICH 风险无关。
