Low Serum Magnesium Levels Are Associated With Hemorrhagic Transformation After Thrombolysis in Acute Ischemic Stroke
Low Serum Magnesium Levels Are Associated With Hemorrhagic Transformation After Thrombolysis in Acute Ischemic Stroke
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低血清镁水平与急性缺血性中风溶栓后出血转化相关
DOI：
10.3389/fneur.2020.00962
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发表时间：
2020-09-02
影响因子：
3.4
通讯作者：
Han, Zhao
中科院分区：
文献类型：
--
作者：
Cheng, Zicheng;Huang, Xiaoyan;Han, Zhao
背景：在急性缺血性卒中患者中，出血性转化是静脉溶栓后的主要并发症。本研究旨在探讨血清镁水平与溶栓后出血性转化(HT)的关系。方法：对温州医科大学附属第二医院中国分院接受溶栓治疗的242例患者的临床资料进行回顾性分析。在静脉溶栓前测量基线血清镁水平，并在治疗后24-36h内回顾计算机断层扫描图像，以评估高血压的发生。采用多变量Logistic回归、亚组分析和限制性三次样条模型分析血清镁水平与高血压的关系。结果：242例入选患者中，43例(17.8%)发生高血压。高血压组血清镁水平显著低于非高血压组(0.81±0.08vs.0.85±0.08，p=0.007)。多因素Logistic回归分析显示，血清镁水平越高，患高血压的风险越低(OR0.1mmo1/L增加0.43，95%CI0.27~0.73，p=0.002)。然而，当基线血清镁水平高于亚组分析中的中位数(0.85mmo1/L)时，这种关联并不存在(每0.1 mmo1/L的OR值增加0.58，95%可信区间0.14-2.51，p=0.47)。在限制三次样条法模型中，当血清镁水平高于0.88mmolL时，这种阈值效应也被观察到。在我们的研究中，没有观察到症状性高血压与血清镁水平之间的关联(OR0.1mmo1/L增加0.52，95%CI0.25-1.11，p=0.092)。结论：缺血性卒中患者较低的血清镁水平与静脉溶栓后发生高血压的风险增加有关，但可能只有当血清镁低于某个最低浓度时才会发生。
Background: In patients with acute ischemic stroke, hemorrhagic transformation is a major complication after intravenous thrombolysis. This study aimed to investigate the relationship between serum magnesium levels and hemorrhagic transformation (HT) after thrombolytic therapy. Methods: We retrospectively analyzed data from 242 patients who received thrombolytic therapy at the Second Affiliated Hospital of the Wenzhou Medical University in China. Baseline serum magnesium levels were measured before intravenous thrombolysis, and the occurrence of HT was evaluated using computed tomography images reviewed within 24–36 h after therapy. The relationship between serum magnesium levels and HT was examined using multivariate logistic regression, subgroup analysis, and restricted cubic spline models. Results: Of the 242 included patients, 43 (17.8%) developed HT. Patients with HT had significant lower serum magnesium levels than those without HT (0.81 ± 0.08 vs. 0.85 ± 0.08 mmol/L, p = 0.007). Multivariable logistic regression analysis indicated that patients with higher serum magnesium levels had lower risk of HT (OR per 0.1-mmol/L increase 0.43, 95% CI 0.27–0.73, p = 0.002). However, this association did not persist when baseline levels of serum magnesium were higher than the median value (0.85 mmol/L) in subgroup analysis (OR per 0.1-mmol/L increase 0.58, 95% CI 0.14–2.51, p = 0.47). This threshold effect was also observed in the restricted cubic spline model when serum magnesium levels were above 0.88 mmol/L. No association between symptomatic HT and serum magnesium levels was observed in our study (OR per 0.1-mmol/L increase 0.52, 95% CI 0.25–1.11, p = 0.092). Conclusions: Lower serum magnesium levels in patients with ischemic stroke are associated with an increased risk of HT after intravenous thrombolysis, but perhaps only when serum magnesium is below a certain minimal concentration.