止血功能与非房颤患者的出血性转化相关：一项病例对照研究。
Hemostasis functions are associated with hemorrhagic transformation in non-atrial fibrillation patients: a case-control study.
机构信息
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
School of Mental Health, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
出版信息
BMC Neurol. 2021 Jan 26;21(1):36. doi: 10.1186/s12883-021-02065-3.
BACKGROUND
Hemorrhagic transformation (HT) is a serious neurological complication of acute ischemic stroke (AIS) after revascularization. The majority of AIS patients do not have atrial fibrillation (AF) which could also develop into HT. In this study, we aimed to explore whether hemostasis parameters are risk factors of HT in non-AF patients.
METHODS
We consecutively enrolled 285 AIS patients with HT. Meanwhile, age- and sex-matched 285 AIS patients without HT were included. The diagnosis of HT was determined by brain CT or MRI during hospitalization. All patients were divided into two subgroups based on the presence of AF and explore the differences between the two subgroups. Blood samples were obtained within 24 h of admission, and all patients were evenly classified into three tertiles according to platelet counts (PLT) levels.
RESULTS
In this study, we found the first PLT tertile (OR = 3.509, 95%CI = 1.268-9.711, P = 0.016) was independently associated with HT in non-AF patients, taking the third tertile as a reference. Meanwhile, we also found mean platelet volume (MPV) (OR = 0.605, 95%CI = 0.455-0.805, P = 0.001) and fibrinogen (FIB) (OR = 1.928, 95%CI = 1.346-2.760, P < 0.001) were significantly associated with HT in non-AF patients. But in AF patients, hemostasis parameters showed no significant difference. Meanwhile, we found the MPV (OR = 1.314, 95%CI = 1.032-1.675, P = 0.027) and FIB (OR = 1.298, 95%CI = 1.047-1.610, P = 0.018) were significantly associated with long-term outcomes in non-AF HT patients.
CONCLUSIONS
Low PLT, low MPV, and high FIB levels were independently associated with HT in non-AF patients. Additionally, MPV and FIB levels were significantly associated with unfavorable long-term outcomes in non-AF HT patients. Our study showed that hemostasis functions at admission may be beneficial for clinicians to recognize patients with a high risk of HT at an early stage and improve unfavorable long-term outcomes in non-AF patients.
背景
出血转化（HT）是急性缺血性脑卒中（AIS）血管再通后的一种严重的神经并发症。大多数 AIS 患者没有心房颤动（AF），但也可能发展为 HT。本研究旨在探讨止血参数是否是非 AF 患者 HT 的危险因素。
方法
我们连续纳入 285 例 HT 的 AIS 患者。同时，纳入年龄和性别匹配的 285 例无 HT 的 AIS 患者作为对照组。住院期间通过脑 CT 或 MRI 诊断 HT。所有患者根据是否存在 AF 分为两组，并比较两组间的差异。入院 24 小时内采集血样，根据血小板计数（PLT）水平将所有患者均分为 3 个三分位数组。
结果
本研究发现，非 AF 患者中，血小板计数最低的三分位数（OR=3.509，95%CI=1.268-9.711，P=0.016）与 HT 独立相关，以第三三分位数为参照。同时，我们还发现平均血小板体积（MPV）（OR=0.605，95%CI=0.455-0.805，P=0.001）和纤维蛋白原（FIB）（OR=1.928，95%CI=1.346-2.760，P<0.001）与非 AF 患者的 HT 显著相关。但在 AF 患者中，止血参数无显著差异。同时，我们发现非 AF HT 患者的 MPV（OR=1.314，95%CI=1.032-1.675，P=0.027）和 FIB（OR=1.298，95%CI=1.047-1.610，P=0.018）与长期预后显著相关。
结论
低血小板计数、低平均血小板体积和高纤维蛋白原水平与非 AF 患者的 HT 独立相关。此外，MPV 和 FIB 水平与非 AF HT 患者的不良长期预后显著相关。本研究表明，入院时的止血功能有助于临床医生早期识别高 HT 风险患者，并改善非 AF 患者的不良长期预后。
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