合并心房颤动对缺血性脑卒中患者静脉溶栓后颅内出血转化的影响

doi:10.3785/j.issn.1008-9292.2019.06.04

浙江大学学报（医学版）

2019, Vol. 48

Issue (3): 254-259 DOI: 10.3785/j.issn.1008-9292.2019.06.04

专题报道

合并心房颤动对缺血性脑卒中患者静脉溶栓后颅内出血转化的影响

陶安阳¹(

),王志敏^1,*(

),陈红芳²,徐冬娟³,胡海芳⁴,吴承龙⁵,张晓玲⁶,马小董⁷,王亚仙⁸,胡海涛⁹,楼敏⁹,浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组

1. 台州市第一人民医院神经内科, 浙江台州 318020
2. 浙江大学金华医院金华市中心医院神经内科, 浙江金华 321000
3. 东阳市人民医院神经内科, 浙江东阳 322100
4. 杭州市萧山区第一人民医院神经内科, 浙江杭州 311201
5. 绍兴市人民医院神经内科, 浙江绍兴 312000
6. 嘉兴市第二医院神经内科, 浙江嘉兴 314000
7. 海盐县人民医院神经内科, 浙江海盐 314300
8. 湖州市中心医院神经内科, 浙江湖州 313003
9. 浙江大学医学院附属第二医院神经内科, 浙江杭州 310009

Association of atrial fibrillation with hemorrhagic transformation after intravenous thrombolysis in patients with ischemic stroke

TAO Anyang¹(

),WANG Zhimin^1,*(

),CHEN Hongfang²,XU Dongjuan³,HU Haifang⁴,WU Chenglong⁵,ZHANG Xiaoling⁶,MA Xiaodong⁷,WANG Yaxian⁸,HU Haitao⁹,LOU Min⁹,Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province

1. Department of Neurology, Taizhou First People's Hospital, Taizhou 318020, Zhejiang Province, China
2. Department of Neurology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
3. Department of Neurology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
4. Department of Neurology, the First People's Hospital of Xiaoshan District, Hangzhou 311201, China
5. Department of Neurology, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
6. Department of Neurology, Jiaxing Second Hospital, Jiaxing 314000, Zhejiang Province, China
7. Department of Neurology, Haiyan People's Hospital, Haiyan 314300, Zhejiang Province, China
8. Department of Neurology, Huzhou Central Hospital, Huzhou 313003, Zhejiang Province, China
9. Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China

全文: PDF(921 KB)

HTML( 6 )

摘要：

目的: 分析合并心房颤动对缺血性脑卒中患者静脉溶栓后颅内出血转化的影响。方法: 收集2017年6月至2018年12月浙江省71家医院3272例静脉溶栓患者的资料。静脉溶栓后24 h影像学检查提示颅内出血表现定义为颅内出血转化。根据患者是否出现出血转化分为出血转化组（533例）和未出血转化组（2739例），采用单因素和二元Logistic回归分析模型分析心房颤动是否与缺血性脑卒中患者静脉溶栓后出血转化相关。结果: 出血转化组患者的年龄、起病至溶栓时间、基线美国国立卫生研究院卒中量表（NIHSS）评分、基线血糖水平、心房颤动患者比例高于未出血转化组（P < 0.05或P < 0.01）。二元Logistic回归分析结果显示，心房颤动与缺血性脑卒中患者静脉溶栓后颅内出血转化的发生独立相关（OR=2.527，95%CI：2.030~3.146，P < 0.01）。结论: 心房颤动与缺血性脑卒中患者静脉溶栓后出血转化增加相关。

关键词： 卒中/治疗; 脑缺血/治疗; 组织型纤溶酶原激活物/治疗应用; 血栓溶解疗法; 心房颤动/病因学; 颅内出血; 危险因素; 回顾性研究

Abstract:

Objective: To investigate the association of atrial fibrillation (AF) with hemorrhagic transformation (HT) in patients with ischemic stroke treated by intravenous thrombolysis. Methods: Clinical data of 3272 patients treated by intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and December 2018 were retrospectively reviewed. Intracranial HT was defined as intracranial hemorrhage suggested by imaging examination 24 hours after intravenous thrombolysis. Patients were dichotomized into HT group (n=533) and non-HT group (n=2739). The association of AF and HT was analyzed by univariate analysis and binary logistic regression. Results: Compared with the non-HT group, the HT group were older, had longer onset to needle time (ONT), higher baseline National Institute of Health Stroke Scale (NIHSS) score, higher baseline glucose level, and higher AF rate (P < 0.05 or P < 0.01). Binary logistic regression analysis revealed that AF was independently associated with HT (OR=2.527, 95%CI:2.030-3.146, P < 0.01). Conclusion: AF is independently associated with the occurrence of HT in ischemic stroke patients treated with intravenous thrombolysis.

Key words: Stroke/therapy Brain ischemia/therapy Tissue plasminogen activator/therapeutic use Thrombolytic therapy Atrial fibrillation/etiology Intracranial hemorrhages Risk factors Retrospective studies

收稿日期: 2019-02-04 出版日期: 2019-09-04

CLC:

R743

基金资助: 浙江省重点研发计划(2018C04011);浙江省公益性技术应用研究计划(2016C33228)

通讯作者: 王志敏 E-mail: taoanyang1990@163.com;welson1980@163.com

作者简介: 陶安阳(1990-), 女, 硕士, 主治医师, 主要从事神经病学研究; E-mail:taoanyang1990@163.com; https://orcid.org/0000-0002-9141-2240

	服务
	把本文推荐给朋友
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陶安阳
	王志敏
	陈红芳
	徐冬娟
	胡海芳
	吴承龙
	张晓玲
	马小董
	王亚仙
	胡海涛
	楼敏
	浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组

引用本文:

陶安阳, 王志敏, 陈红芳, 徐冬娟, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 楼敏, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 合并心房颤动对缺血性脑卒中患者静脉溶栓后颅内出血转化的影响[J]. 浙江大学学报（医学版）, 2019, 48(3): 254-259.

TAO Anyang, WANG Zhimin, CHEN Hongfang, XU Dongjuan, HU Haifang, WU Chenglong, ZHANG Xiaoling, MA Xiaodong, WANG Yaxian, HU Haitao, LOU Min, Improving In-hospital Stroke Service Utilisation (MISSION) in Zhejiang Province . Association of atrial fibrillation with hemorrhagic transformation after intravenous thrombolysis in patients with ischemic stroke. J Zhejiang Univ (Med Sci), 2019, 48(3): 254-259.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.06.04 或 http://www.zjujournals.com/med/CN/Y2019/V48/I3/254

表 1 缺血性脑卒中患者合并心房颤动组与非心房颤动组基线特征比较

表 2 缺血性脑卒中患者静脉溶栓治疗后出血转化组和未出血转化组临床资料比较

表 3 缺血性脑卒中患者静脉溶栓治疗后出血转化危险因素的二元Logistic回归分析结果

1	The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group . Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med, 1995, 333 (24): 1581- 1587 doi: 10.1056/NEJM199512143332401
2	HACKE W , KASTE M , BLUHMKI E et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J]. N Engl J Med, 2008, 359 (13): 1317- 1329 doi: 10.1056/NEJMoa0804656
3	周自强, 胡大一, 陈捷 et al. 中国心房颤动现状的流行病学研究[J]. 中华内科杂志, 2004, 43 (7): 236- 493 ZHOU Ziqiang , HU Dayi , CHEN Jie et al. An epidemiological survey of atrial fibrillation in China[J]. Chinese Journal of Internal Medicine, 2004, 43 (7): 236- 493
4	BORIANI G , BOTTO G L , PADELETTI L et al. Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring[J]. Stroke, 2011, 42 (6): 1768- 1770 doi: 10.1161/STROKEAHA.110.609297
5	娄一萍, 严慎强, 张圣 et al. 合并心房颤动对急性缺血性卒中患者静脉溶栓治疗后临床结局的影响[J]. 浙江大学学报(医学版), 2014, 43 (1): 28- 35 LOU Yiping , YAN Shenqiang , ZHANG Sheng et al. Impact of atrial fibrillation on clinical outcome in patients with acute ischemic stroke undergoing thrombolytic therapy[J]. Journal of Zhejiang University (Medical Sciences), 2014, 43 (1): 28- 35 doi: 10.3785/j.issn.1008-9292.2014.01.020
6	黄从新, 张澍, 黄德嘉 et al. 心房颤动:目前的认识和治疗建议(2018)[J]. 中华心律失常学杂志, 2018, 22 (4): 279- 346 HUANG Congxin , ZHANG Shu , HUANG Dejia et al. Current knowledge and management recommendations of atrial fibrillation:2018[J]. Chinese Journal of Cardiac Arrhythmias, 2018, 22 (4): 279- 346 doi: 10.3760/cma.j.issn.1007-6638.2018.04.002
7	ASBERG S , HENRIKSSON K M , FARAHMAND B et al. Ischemic stroke and secondary prevention in clinical practice:a cohort study of 14, 529 patients in the Swedish Stroke Register[J]. Stroke, 2010, 41 (7): 1338- 1342 doi: 10.1161/STROKEAHA.110.580209
8	SANáK D , HERZIG R , KRáL M et al. Is atrial fibrillation associated with poor outcome after thrombolysis?[J]. J Neurol, 2010, 257 (6): 999- 1003 doi: 10.1007/s00415-010-5452-4
9	KIMURA K , IGUCHI Y , SHIBAZAKI K et al. Ⅳ t-PA therapy in acute stroke patients with atrial fibrillation[J]. J Neurol Sci, 2009, 276 (1-2): 6- 8 doi: 10.1016/j.jns.2008.10.018
10	BLUHMKI E , CHAMORRO A , DáVALOS A et al. Stroke treatment with alteplase given 3.0-4.5 h after onset of acute ischaemic stroke (ECASS Ⅲ):additional outcomes and subgroup analysis of a randomised controlled trial[J]. Lancet Neurol, 2009, 8 (12): 1095- 1102 doi: 10.1016/S1474-4422(09)70264-9
11	SANDERCOCK P , WARDLAW J M , LINDLEY R I et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial[IST-3]):a randomised controlled trial[J]. Lancet, 2012, 379 (9834): 2352- 2363 doi: 10.1016/S0140-6736(12)60768-5
12	FRANK B , FULTON R , WEIMAR C et al. Impact of atrial fibrillation on outcome in thrombolyzed patients with stroke:evidence from the Virtual International Stroke Trials Archive (VISTA)[J]. Stroke, 2012, 43 (7): 1872- 1877 doi: 10.1161/STROKEAHA.112.650838
13	YUE R, LI D, YU J, et al. Atrial fibrillation is associated with poor outcomes in thrombolyzed patients with acute ischemic stroke: a systematic review and meta-analysis[J/OL]. Medicine(Baltimore), 2016, 95(10): e3054.
14	SAPOSNIK G , GLADSTONE D , RAPTIS R et al. Atrial fibrillation in ischemic stroke predicting response to thrombolysis and clinical outcomes[J]. Neurology, 2013, 44 (21): 99- 104
15	BIVARD A , LIN L , PARSONSB M W . Review of stroke thrombolytics[J]. J Stroke, 2013, 15 (2): 90- 98 doi: 10.5853/jos.2013.15.2.90
16	TU H T , CAMPBELL B C , CHRISTENSEN S et al. Pathophysiological determinants of worse stroke outcome in atrial fibrillation[J]. Cerebrovasc Dis, 2010, 30 (4): 389- 395 doi: 10.1159/000316886
17	TU H T , CAMPBELL B C , CHRISTENSEN S et al. Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation[J]. Int J Stroke, 2015, 10 (4): 534- 540 doi: 10.1111/ijs.12007
18	FINDLER M , MOLAD J , BORNSTEIN N M et al. Worse outcome in patients with acute stroke and atrial fibrillation following thrombolysis[J]. Isr Med Assoc J, 2017, 19 (5): 293- 295
19	KIMURA K , SHIBAZAKI K , IGUCHI Y et al. The combination of elevated BNP and AF as a predictor of no early recanalization after Ⅳ-t-PA in acute ischemic stroke[J]. J Neurol Sci, 2010, 290 (1-2): 37- 40 doi: 10.1016/j.jns.2009.11.014
20	NAESS H , WAJE-ANDREASSEN U , THOMASSEN L . Persistent atrial fibrillation is associated with worse prognosis than paroxysmal atrial fibrillation in acute cerebral infarction[J]. ISRN Cardiol, 2012, 2012:650915

[1]	胡琳琳,张睿婷,王淑玥,洪慧,黄沛钰,张敏鸣. 心脑血管疾病高危因素对脑铁沉积影响的磁共振影像学研究[J]. 浙江大学学报（医学版）, 2019, 48(6): 644-650.
[2]	王林燕,薛佳金,陈益,吕成杰,黄寿奖,钭金法,高志刚,陈青江. 新生儿环状胰腺的临床诊治分析[J]. 浙江大学学报（医学版）, 2019, 48(5): 481-486.
[3]	马东,赖登明,赵晓霞,胡书奇,吕成杰,黄寿奖,秦琪,钭金法. Ⅲ-b型先天性肠闭锁患儿的治疗[J]. 浙江大学学报（医学版）, 2019, 48(5): 487-492.
[4]	王展,唐达星,田红娟,杨帆,温弘,王军梅,陶畅. 肾盂前后径对肾积水胎儿出生后是否手术的预测价值[J]. 浙江大学学报（医学版）, 2019, 48(5): 493-498.
[5]	林静,陈志敏. 儿童重症腺病毒肺炎早期识别的研究进展[J]. 浙江大学学报（医学版）, 2019, 48(5): 567-572.
[6]	张树超,祝成,叶有新,李华. 经皮腔内血管成形术结合药物溶栓治疗动静脉内瘘急性血栓形成的疗效观察[J]. 浙江大学学报（医学版）, 2019, 48(5): 533-539.
[7]	麦合木提江·穆扎帕,周敏. 腹主动脉瘤腔内修复术中髂内动脉封堵后盆腔缺血症状发生的危险因素[J]. 浙江大学学报（医学版）, 2019, 48(5): 546-551.
[8]	张丹丹,王军梅. 胎儿肝血管瘤的产前影像学诊断和管理[J]. 浙江大学学报（医学版）, 2019, 48(4): 439-445.
[9]	童凡,杨茹莱,刘畅,吴鼎文,张婷,黄新文,洪芳,钱古柃,黄晓磊,周雪莲,舒强,赵正言. 新生儿酪氨酸血症筛查及基因谱分析[J]. 浙江大学学报（医学版）, 2019, 48(4): 459-464.
[10]	张建民. 缺血性脑血管疾病手术治疗新进展[J]. 浙江大学学报（医学版）, 2019, 48(3): 233-240.
[11]	钟晚思, 陈智才, 陈红芳, 徐冬娟, 王志敏, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 楼敏, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 院前急救医疗服务对缺血性脑卒中患者静脉溶栓预后的影响[J]. 浙江大学学报（医学版）, 2019, 48(3): 241-246.
[12]	陈红芳, 龚筱弦, 徐冬娟, 王志敏, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 楼敏, 陈智才, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 治疗时间提前可改善缺血性脑卒中患者再灌注治疗的预后[J]. 浙江大学学报（医学版）, 2019, 48(3): 247-253.
[13]	张聪聪, 楼敏, 陈智才, 陈红芳, 徐冬娟, 王志敏, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 医院内缺血性脑卒中患者静脉溶栓时间及预后分析[J]. 浙江大学学报（医学版）, 2019, 48(3): 260-266.
[14]	泮飞虎, 楼敏, 陈智才, 陈红芳, 徐冬娟, 王志敏, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 不同工作时间段就诊对缺血性脑卒中患者静脉溶栓预后的影响[J]. 浙江大学学报（医学版）, 2019, 48(3): 267-274.
[15]	付涧兰,宋法寰,程爱萍. 脂肪肉瘤的¹⁸F-氟代脱氧葡萄糖PET-CT显像特征[J]. 浙江大学学报（医学版）, 2019, 48(2): 193-199.

Viewed

Full text

Abstract

Cited

Shared

Discussed