Honig Asaf, Percy Jennifer, Sepehry Amir A, Gomez Alejandra G, Field Thalia S, Benavente Oscar R
Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
J Clin Med. 2022 Feb 22;11(5):1162. doi: 10.3390/jcm11051162.
The prevalence and risk factors of hemorrhagic transformation (HT) after acute ischemic stroke HT have not been adequately delineated. We performed a systematic review and meta-analysis to identify English-language prospective observational MEDLINE and EMBASE-listed reports of acute ischemic stroke with HT published from 1985-2017. Studies that used the ECASS-2 definitions of hemorrhagic transformation subtypes, hemorrhagic infarction (HI), and parenchymal hematoma (PH) were included. Patients treated with intravenous thrombolysis with tissue plasminogen activator (IV-tPA) were compared with those who did not receive thrombolysis. A total of 65 studies with 17,259 patients met inclusion criteria. Overall, HT prevalence was 27%; 32% in patients receiving IV-tPA vs. 20% in those without. Overall PH prevalence was 9%; 12% in IV-tPA treated patients vs. 5% in those without. HT was associated with a history of atrial fibrillation (OR 2.94) and use of anticoagulants (OR 2.47). HT patients had higher NIHSS (Hedge's-G 0.96) and larger infarct volume (diffusion-weighted MRI, Hedge's-G 0.8). In IV-tPA treated patients, PH correlated with antiplatelet (OR 3) and statin treatment (OR 4). HT (OR 3) and PH (OR 8) were associated with a poor outcome at 90-day (mRS 5-6). Hemorrhagic transformation is a frequent complication of acute ischemic stroke and is associated with poor outcome. Recognition of risk factors for HT and PH may reduce their incidence and severity.
急性缺血性卒中后出血性转化（HT）的患病率及危险因素尚未得到充分阐明。我们进行了一项系统评价和荟萃分析，以识别1985年至2017年发表的英文前瞻性观察性MEDLINE和EMBASE收录的急性缺血性卒中合并HT的报告。纳入使用欧洲急性卒中协作研究-2（ECASS-2）出血性转化亚型定义（即出血性梗死（HI）和脑实质血肿（PH））的研究。将接受组织型纤溶酶原激活剂静脉溶栓（IV-tPA）治疗的患者与未接受溶栓治疗的患者进行比较。共有65项研究、17259例患者符合纳入标准。总体而言，HT患病率为27%；接受IV-tPA治疗的患者中为32%，未接受治疗的患者中为20%。总体PH患病率为9%；IV-tPA治疗的患者中为12%，未接受治疗的患者中为5%。HT与房颤病史（比值比[OR]2.94）和抗凝剂使用（OR 2.47）相关。HT患者美国国立卫生研究院卒中量表（NIHSS）评分更高（赫奇斯G值0.96），梗死体积更大（扩散加权磁共振成像，赫奇斯G值0.8）。在接受IV-tPA治疗的患者中，PH与抗血小板治疗（OR 3）和他汀类药物治疗（OR 4）相关。HT（OR 3）和PH（OR 8）与90天时不良预后（改良Rankin量表[mRS]评分5 - 6）相关。出血性转化是急性缺血性卒中的常见并发症，且与不良预后相关。识别HT和PH的危险因素可能会降低其发生率和严重程度。
