Early hemorrhagic transformation of brain infarction: Rate, predictive factors, and influence on clinical outcome - Results of a prospective multicenter study
Early hemorrhagic transformation of brain infarction: Rate, predictive factors, and influence on clinical outcome - Results of a prospective multicenter study
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DOI：
10.1161/strokeaha.107.510321
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发表时间：
2008-08-01
期刊：
影响因子：
8.3
通讯作者：
Silvestrelli, Giorgio
中科院分区：
文献类型：
--
作者：
Paciaroni, Maurizio;Agnelli, Giancarlo;Silvestrelli, Giorgio
背景和目的：早期出血性转化（HT）是缺血性卒中的一种并发症，但其对患者预后的影响尚不清楚。本研究的目的是评估：（1）缺血性卒中患者早期HT的发生率，（2）早期HT与3个月时功能结局之间的相关性，以及（3）早期HT的危险因素。方法：在4个研究中心进行的前瞻性研究中纳入了缺血性卒中患者。通过在卒中发作后第5 +/-2天进行的CT检查评估早期HT。研究结果为3个月死亡率或残疾率。由不知道个体病例中HT发生的神经科医生使用改良的兰金评分（>= 3表示致残性卒中）评估残疾。采用卡方检验比较早期HT患者和非早期HT患者的结局。多元Logistic回归分析，以确定预测HT。结果-在1125例连续患者（中位年龄76.00岁），98（8.7%）HT，62（5.5%）有出血性梗死，36（3.2%）脑实质血肿。3个月时，455例患者（40.7%）残疾或死亡。1021例非HT患者中，387例（37.9%）死亡或残疾，33例（91.7%）有脑实质血肿，35例（57.4%）有出血性梗死。在逻辑回归分析中，脑实质血肿（而非出血性梗死）与死亡或残疾风险增加独立相关（OR 15.29; 95%CI 2.35 - 99.35）。在逻辑回归分析中，脑实质血肿是由大病灶预测的，（OR 12.20，95% CI 5.58 - 26.67），心源性栓塞导致的卒中（OR 5.25; 95% CI 2.27 - 12.14）或其他原因（OR 6.77; 95% CI 1.75 - 26.18），高血糖水平（OR 1.01; 95% CI 1.00 ~ 1.01）和溶栓治疗（OR 3.54，95% CI 1.04 ~ 11.95）。约3%的患者出现脑实质血肿，与不良结局相关。心源性栓塞或其他原因引起的大病灶、高血糖和溶栓治疗可预测脑实质血肿。
Background and Purpose - Early hemorrhagic transformation ( HT) is a complication of ischemic stroke but its effect on patient outcome is unclear. The aims of this study were to assess: ( 1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and ( 3) the risk factors for early HT.Methods - Consecutive patients with ischemic stroke were included in this prospective study in 4 study centers. Early HT was assessed by CT examination performed at day 5 +/- 2 after stroke onset. Study outcomes were 3-month mortality or disability. Disability was assessed using a modified Rankin score (>= 3 indicating disabling stroke) by neurologists unaware of the occurrence of HT in the individual cases. Outcomes in patients with and without early HT were compared by chi(2) test. Multiple logistic regression analysis was used to identify predictors for HT.Results - Among 1125 consecutive patients (median age 76.00 years), 98 ( 8.7%) had HT, 62 (5.5%) had hemorrhagic infarction, and 36 (3.2%) parenchymal hematoma. At 3 months, 455 patients (40.7%) were disabled or died. Death or disability was seen in 33 patients with parenchymal hematoma (91.7%), in 35 patients with hemorrhagic infarction (57.4%) as compared with 387 of the 1021 patients without HT (37.9%). At logistic regression analysis, parenchymal hematoma, but not hemorrhagic infarction, was independently associated with an increased risk for death or disability (OR 15.29; 95% CI 2.35 to 99.35). At logistic regression analysis, parenchymal hematoma was predicted by large lesions (OR 12.20, 95% CI 5.58 to 26.67), stroke attributable to cardioembolism ( OR 5.25; 95% CI 2.27 to 12.14) or to other causes (OR 6.77; 95% CI 1.75 to 26.18), high levels of blood glucose (OR 1.01; 95% CI 1.00 to 1.01), and thrombolytic treatment (OR 3.54, 95% CI 1.04 to 11.95).Conclusions - Early HT occurs in about 9% of patients. Parenchymal hematoma, seen in about 3% of patients, is associated with an adverse outcome. Parenchymal hematoma was predicted by large lesions attributable to cardioembolism or other causes, high blood glucose, and treatment with thrombolysis.