Please wait a minute...
Journal of ZheJiang University(Medical Science)  2014, Vol. 43 Issue (1): 20-27    DOI: 10.3785/j.issn.1008-9292.2014.01.019
    
Impact of cerebral microbleeds on outcomes of acute ischemic stroke treated with intravenous thrombolysis
YAN Shen-qiang, WAN Jin-ping, GUO Yang, LOU Min
Department of Neurology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
Download:   PDF(789KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To assess the impact of cerebral microbleeds (CMBs) on clinical outcomes in patients with acute ischemic stroke treated by intravenous thrombolysis.
Methods: The clinical data of 225 patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator therapy in the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2009 to May 2013 were reviewed. The severity of CMBs and hemorrhagic transformation (HT) after thrombolytic therapy and clinical neurological outcome based on modified Rankin scale (mRS) at 3 months were evaluated. Favorable outcome was defined as mRS 0-1 and unfavorable outcome as mRS 2-6. Multivariate logistic-regression analysis and binary logistic-regression were used to determine independent risk factors of HT and favorable outcome.
Results: The mean age of 225 patients was (66.29±13.01) y, 73 (32.4%) patients were women, mean pretreatment National Institutes of Health Stroke Scale (NIHSS) score was 11.40±5.89, and onset-to-needle time was (238.40±89.16) min. Totally, 522 CMBs were detected in 91 patients (36.1%). Postlytic radiological HT was found in 64 patients (28.4%), among which 43 (19.1%) were hemorrhagic infarction and 21 (9.3%) were parenchymal hematoma. Univariate analysis showed that patients with HT had higher NIHSS score and more incidence of atrial fibrillation and that patients with unfavorable outcome were older and had higher NIHSS score and more CMBs. Multivariate logistic regression analysis showed that multiple CMBs (≥3) was independently associated with parenchymal hematoma (OR=4.957, 95%CI 1.306-18.811, P=0.019), but not with hemorrhagic infarction (OR=1.204, 95%CI 0.386-3.754, P=0.749). Binary logistic regression analysis showed that multiple CMBs (≥3) was independently associated with unfavorable outcome (OR=3.496, 95%CI 1.381-8.849, P=0.008).
Conclusion: Multiple CMBs are correlated with parenchymal hematoma and unfavorable neurological outcome after thrombolytic therapy in patients with acute ischemic stroke.



Key wordsHemorrhage      Intracranial hemorrhages      Brain      Acute disease      Brain ischemia/drug therapy      Stroke/drug therapy      Tissue plasminogen activator/therapeutic use      Thrombolytic therapy      Logistic models      Prognosis      Nervous system      Statistics (as topic)     
Received: 26 November 2013      Published: 30 December 2013
Cite this article:

YAN Shen-qiang, WAN Jin-ping, GUO Yang, LOU Min. Impact of cerebral microbleeds on outcomes of acute ischemic stroke treated with intravenous thrombolysis. Journal of ZheJiang University(Medical Science), 2014, 43(1): 20-27.

URL:

http://www.zjujournals.com/xueshu/med/10.3785/j.issn.1008-9292.2014.01.019     OR     http://www.zjujournals.com/xueshu/med/Y2014/V43/I1/20


合并颅内微出血对急性缺血性卒中患者静脉溶栓治疗后临床结局的影响

目的:明确合并颅内微出血对急性缺血性卒中患者静脉重组组织型纤溶酶原激活剂(rt-PA)溶栓后的出血转化以及3个月后神经功能结局的影响。
方法:连续收集225例2009年6月至2013年5月期间在浙江大学医学院附属第二医院神经内科接受静脉rt-PA溶栓治疗并行磁敏感序列检查的急性缺血性卒中患者的临床及实验室检查资料,评估患者溶栓后出血转化情况及3个月改良Rankin量表,在磁敏感序列上评估微出血严重程度。采用多元logistic回归分析出血转化,以无出血转化为参照,分析不同出血转化类型的影响因素;采用二元logistic回归分析症状性出血与神经功能结局的影响因素。
结果:225例患者平均年龄(66.29±13.01)岁,女性73例(32.4%),发病至溶栓时间为(238.40±89.16)min,溶栓前美国国立卫生研究院卒中量表(NIHSS)评分为(11.40±5.89)分;共91例(36.1%)合并颅内微出血,微出血数目总计522个;共64例(28.4%)发生溶栓后出血转化,其中43例(19.1%)为出血性脑梗死型,21例(9.3%)为脑实质血肿型。多元logistic回归分析结果提示,多发(≥3个)颅内微出血增加溶栓治疗后脑实质血肿型出血转化(OR=4.957,95%CI 1.306~18.811,P=0.019)。二元logistic回归分析结果提示,多发(≥3个)颅内微出血是溶栓治疗后神经功能不良的独立危险因素(OR=3.496,95%CI 1.381~8.849,P=0.008)。
结论:多发(≥3个)颅内微出血增加急性缺血性卒中患者静脉rt-PA溶栓后的脑实质血肿型出血转化风险,并与溶栓治疗后3个月不良神经功能结局有关。


关键词: 出血,  颅内出血,  脑,  急性病,  脑缺血/药物疗法,  卒中/药物疗法,  组织型纤溶酶原激活物/治疗应用,  血栓溶解疗法,  Logistic模型; 预后,  神经系统,  统计学(主题) 
[1] CAI Cheng,WANG Jianping,ZHONG Zhifeng,DAI Zhihui,WANG Qinghua,DONG Wuzhen,SHI Hongqi,LIU Qingwei,DU Jinlin. Hypoxia-inducible factor-1α and CD133 predicts pathological complete response and survival for locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy[J]. Journal of ZheJiang University(Medical Science), 2017, 46(1): 36-43.
[2] BAI Shi, SUN Yayi, WU Lijuan, WU Zhongmin, FANG Marong. Tripotolide ameliorates inflammation and apoptosis induced by focal cerebral ischemia/reperfusion in rats[J]. Journal of ZheJiang University(Medical Science), 2016, 45(5): 493-500.
[3] YANG Suwen, WANG Wei, JIN Hong, ZHONG Yuhong, XIE Xinyou. Expression of microRNA-221/222 in patients with monoclonal gammopathy of undetermined significance and multiple myeloma[J]. Journal of ZheJiang University(Medical Science), 2016, 45(4): 371-378.
[4] JI Yongjia, LU Hongzhou. Advances of immunological pathogenesis research in HIV related neurocognitive disorder[J]. Journal of ZheJiang University(Medical Science), 2016, 45(3): 249-255.
[5] LU Junxiu, YANG Bingyan, CHEN Jingguo, XU Huanli, CHEN Haiyan. Effect of cerebral hemodynamic changes on white matter damage in premature infant with patent ductus arteriosus[J]. Journal of ZheJiang University(Medical Science), 2016, 45(3): 287-291.
[6] XU Yulan, XUE Yadan, KANG Lijun. The effect of glial cells in the function and development of the nervous system in Caenorhabditis elegans[J]. Journal of ZheJiang University(Medical Science), 2016, 45(3): 315-322.
[7] BIAN Wei, GUAN Jichao, XIE Xishao, TONG Jin, ZHANG Xiaohui, SHOU Zhangfei. Effects of interim hemodialysis on survival and clinical outcomes in patients with maintenance peritoneal dialysis[J]. Journal of ZheJiang University(Medical Science), 2016, 45(2): 195-200.
[8] YAO Zhongkai, YANG Chensong, SUN Guixin. Research progress of induced pluripotent stem cells in treatment of muscle atrophy[J]. Journal of ZheJiang University(Medical Science), 2016, 45(2): 147-151.
[9] LANG Xiabing, YANG Yi, CHEN Jianghua. Epidemiology of acute kidney injury in hospitalized patients in China[J]. Journal of ZheJiang University(Medical Science), 2016, 45(2): 208-213.
[10] XU Fangying, LIU Qin, HAN Fengyan, XU Enping, LAI Maode, ZHAO Zhongsheng. Association of neuroendocrine differentiation with progression and prognosis of gastric adenocarcinoma[J]. Journal of ZheJiang University(Medical Science), 2016, 45(1): 24-30.
[11] CHEN Qing-meng, XU Lyu-yi, YAN Shen-qiang, ZHANG Xiao-cheng, ZHANG Sheng, LOU Min. Thrombus length evaluated by CT perfusion imaging and its value in prediction of recanalization after intravenous thrombolysis therapy[J]. Journal of ZheJiang University(Medical Science), 2015, 44(6): 611-617.
[12] YANG Wan-hua, WU Hai-ying, ZHANG Hong-ze, LIU Hong-xiang, WEI Yu-jie, SHI Bin. Prognostic value of Picco monitoring combined with plasma microRNA-150 detection in septic shock patients[J]. Journal of ZheJiang University(Medical Science), 2015, 44(6): 659-664.
[13] LIU Ke-qin, CHEN Qing-meng, YAN Shen-qiang, ZHANG Sheng, LOU Min. Relationship between early blood pressure variability and reperfusion in acute ischemic stroke patients with intravenous thrombolysis[J]. Journal of ZheJiang University(Medical Science), 2015, 44(6): 603-610,617.
[14] ZHAI Li-ping, CHEN Zhi-cai, YAN Shen-qiang, ZHONG Gen-long, ZHANG Sheng, XU Meng-jun, LOU Min. Older age is not related to hemorrhagic transformation and favorable outcomes in patients with wake-up ischemic stroke undergoing intravenous thrombolytic therapy[J]. Journal of ZheJiang University(Medical Science), 2015, 44(6): 638-644.
[15] XU Chao, CHEN Zhi-cai, TANG Huan, XU Meng-jun, ZHANG Sheng, SUN Jian-zhong, LOU Min. Signifiance of brush sign on susceptibility-weighted imaging predicts hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke[J]. Journal of ZheJiang University(Medical Science), 2015, 44(6): 625-631.