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目的:探讨脑梗死发病前使用抗栓药物治疗对急性脑梗死后出血转化的影响。方法:选取2005-05-2015-05在我院神经内科住院的急性脑梗死患者为研究对象,根据我院脑梗死登记库中信息收集所有这些患者的全部资料,包括入院时的基本资料,既往的治疗史(主要是抗凝药物以及抗血小板聚集药物的具体使用情况)和头部CT/MRI以及脑血管等影像学资料。根据入院后48h的头部CT/MRI的结果,将出血转化患者纳入到出血转化组,从非出血转化患者中选取和出血转化组数量、性别、年龄非常匹配的患者纳入为非出血转化组。对比2组患者的用药情况和基线情况,对2组间有差异的危险因素进行多因素Logistic回归分析,研究脑梗死发病前使用抗栓药物治疗与急性脑梗死后出血转化的关系。结果:共纳入7 524例急性脑梗死患者,其中489例(6.5%)纳入出血转化组,性别、年龄和病程均与出血转化组匹配的未出血转化组患者也纳入489例(6.5%)。2组患者入院时美国国立卫生研究院脑卒中量表(NIHSS)评分、既往脑梗死病史以及心房颤动比较差异有着显著统计学意义(均P<0.05)。出血转化组病前使用抗拴药物的比例均显著高于非出血转化组(P<0.05)。多因素Logistic回归分析结果表明,入院时的NIHSS评分、心房颤动、既往脑梗死病史以及抗栓药物的使用均为出血转化的独立危险因素(P<0.05)。结论:脑梗死发病前使用抗栓药物治疗与急性脑梗死后出血转化独立相关,其与急性脑梗死预后的疗效关系还有待进一步的探讨。
Objective: To investigate the effect of antithrombotic therapy before cerebral infarction on the hemorrhagic transformation after acute cerebral infarction. Methods: The patients with acute cerebral infarction who were hospitalized in Department of Neurology of our hospital from May 2005 to May 2015 were selected as the research objects. All the data of all these patients were collected according to the information of the registration database of cerebral infarction in our hospital, including the basic data of admission, (Mainly the specific usage of anticoagulant drugs and anti-platelet aggregation drugs) and imaging data of head CT / MRI and cerebrovascular. According to CT / MRI findings at 48h after admission, patients with hemorrhagic transformation were included in the hemorrhagic transformation group. Patients without non-hemorrhagic transformation who were matched to the number of hemorrhagic transformation group, gender, and age were included in the non-hemorrhagic transformation group. Multivariate Logistic regression analysis was used to compare the medication and baseline conditions of two groups of patients with risk factors to study the relationship between the use of antithrombotic therapy before onset of cerebral infarction and hemorrhage and conversion after acute cerebral infarction. Results: A total of 7 524 patients with acute cerebral infarction were enrolled. Among them, 489 (6.5%) were enrolled in the hemorrhagic transformation group, and 489 (6.5%) were enrolled in the untransfusion group matched with the hemorrhagic conversion group by sex, age and duration. NIHSS scores, past history of cerebral infarction, and atrial fibrillation were significantly different between the two groups (all P <0.05). The proportion of anti-tethered drugs used in the hemorrhagic transformation group was significantly higher than that in the non-hemorrhagic conversion group (P <0.05). Multivariate logistic regression analysis showed that admission NIHSS score, atrial fibrillation, history of previous cerebral infarction and the use of antithrombotic drugs were independent risk factors for hemorrhage conversion (P <0.05). Conclusion: The use of antithrombotic therapy prior to the onset of cerebral infarction is independently related to the hemorrhagic transformation after acute cerebral infarction. The relationship between the curative effect and the prognosis of acute cerebral infarction remains to be further explored.