Troponin Elevation on Admission Along With Dynamic Changes and Their Association With Hemorrhagic Transformation After Thrombolysis.
Troponin Elevation on Admission Along With Dynamic Changes and Their Association With Hemorrhagic Transformation After Thrombolysis.
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入院时肌钙蛋白升高以及动态变化及其与溶栓后出血转化的关系。
DOI：
10.3389/fnagi.2021.758678
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发表时间：
2021
影响因子：
4.8
通讯作者：
Han Z
中科院分区：
文献类型：
--
作者：
Cheng Z;Zhan Z;Huang X;Xia L;Xu T;Han Z
背景：出血性转化（HT）是阿替普酶静脉溶栓的常见并发症。心肌肌钙蛋白与急性缺血性脑卒中患者预后不良和认知功能障碍有关。但关于溶栓后肌钙蛋白与HT之间关系的研究较少。方法：回顾性分析2015年6月至2021年6月温州医科大学第二附属医院的溶栓患者。在入院时和随后几天测量心肌肌钙蛋白I，以确定是否存在升高和动态变化。治疗后24-36小时内通过颅脑计算机断层扫描（CT）确诊HT。此外，出院时修改的Rankin量表（mRS）的评分为>2分为不良预后。采用单因素分析探讨入院时肌钙蛋白升高及肌钙蛋白动态变化的相关因素。采用多因素logistic回归模型分别探讨入院时肌钙蛋白升高、溶栓后肌钙蛋白动态变化与HT的关系。结果：377例患者入院时检测了肌钙蛋白水平，292例（77.5%）患者进行了随访检测。入院时肌钙蛋白升高39例（10.3%），肌钙蛋白动态变化66例（22.6%）。先前存在的心脏病、肾功能不全和较高的卒中严重程度与入院时肌钙蛋白升高和随后的肌钙蛋白动态变化有关。调整潜在混杂因素后，logistic回归模型显示，入院时肌钙蛋白升高的患者发生HT的趋势不显著（OR 2.23, 95%CI 0.96 ~ 5.21, p = 0.063），而肌钙蛋白动态变化的患者发生HT的风险显著增高（OR 2.27, 95%CI 1.06 ~ 4.85, p = 0.034）。与肌钙蛋白升高相比，肌钙蛋白动态变化与不良结局之间存在统计学上更强的关联（OR 2.20, 95%CI 1.05-4.60, p = 0.037）。结论：溶栓后肌钙蛋白动态变化与HT相关。对于有肌钙蛋白动态变化相关危险因素（如高龄、既往心脏病、NIHSS评分较高、入院时肌钙蛋白升高）的溶栓患者，系列测量是非常必要的。
Background: Hemorrhagic transformation (HT) is a common complication of intravenous thrombolysis with alteplase. Cardiac troponin has been found to be associated with poor prognosis and cognitive impairment in acute ischemic stroke. But studies on the relationship between troponin and HT after thrombolysis are scarce. Methods: This study retrospectively analyzed thrombolytic patients from June 2015 to June 2021 in the Second Affiliated Hospital of Wenzhou Medical University. Cardiac troponin I were measured on admission and on following days to determine the presence of elevation and dynamic changes. HT within 24–36 h after treatment was identified by cranial computed tomography (CT). Besides, a score on the modified Rankin Scale (mRS) > 2 at discharge was defined as unfavorable outcome. Univariate analysis was used to explore the factors related to the troponin elevation on admission and troponin dynamic changes. Multivariate logistic regression model was used to investigated the association between troponin elevation on admission, troponin dynamic changes and HT after thrombolysis, respectively. Results: Troponin levels on admission were measured in 377 patients, and follow-up assay was performed in 292 patients (77.5%). 39 patients (10.3%) had troponin elevation on admission, and 66 patients (22.6%) had troponin dynamic changes comprising rising and falling pattern. The pre-existing heart disease, renal insufficiency and higher stroke severity are related to both troponin elevation on admission and the subsequent troponin dynamic changes. After adjusting the potential confounding factors, logistic regression model showed that patients with troponin elevation on admission had insignificant trend to develop HT (OR 2.23, 95%CI 0.96–5.21, p = 0.063), while patients with troponin dynamic changes had significantly higher risk of HT (OR 2.27, 95%CI 1.06–4.85, p = 0.034). Compared to the troponin elevation, a statistically stronger association was present between rising troponin dynamic changes and unfavorable outcome (OR 2.20, 95%CI 1.05–4.60, p = 0.037). Conclusion: Troponin dynamic changes are associated with HT after thrombolysis. Serial measurements are quite necessary in thrombolytic patients with risk factors associated with troponin dynamic changes (e.g., advanced age, pre-existing heart disease, higher NIHSS score, and troponin elevation on admission).
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影响因子：
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Scheitz JF;Stengl H;Nolte CH;Landmesser U;Endres M
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