摘要
目的探讨急性脑梗死患者不同出血转化类型与血清尿酸的关系。方法回顾性分析2018年6月至2020年12月浙江省金华市中心医院365例急性脑梗死患者的临床资料,记录患者的临床资料及入院时血清尿酸水平,统计出血性脑梗死(HI)和脑实质血肿(PH)发生情况。采用多因素Logistic回归分析影响急性脑梗死患者发生HI、PH的危险因素。结果365例患者中,未发生出血转化328例(对照组);发生出血转化37例(10.1%),HI 20例(HI组),PH 17例(PH组)。PH组尿酸明显低于对照组和HI组[(243.59±61.49)μmol/L比(307.84±80.12)和(305.45±94.99)μmol/L],差异有统计学意义(P<0.05);对照组与HI组尿酸比较差异无统计学意义(P>0.05)。根据血清尿酸三分位数将患者分为三组,尿酸≤264.9μmol/L 121例(Ⅰ组),265.0~338.8μmol/L 122例(Ⅱ组)和≥338.9μmol/L 122例(Ⅲ组)。Ⅲ组PH率明显低于Ⅰ组[0.8%(1/122)比8.3%(10/121)],差异有统计学意义(P<0.05)。以未发生出血转化患者为参照,多因素Logistic回归分析结果表明,糖尿病、心房颤动、大面积梗死是急性脑梗死患者发生HI的独立危险因素(P<0.01);年龄、大面积脑梗死、溶栓治疗、血小板计数、尿酸是急性脑梗死患者发生PH的独立危险因素(P<0.05或<0.01)。结论急性脑梗死患者中,较高的血清尿酸与较低的PH独立相关,与HI无相关性,血清尿酸水平对预测PH具有一定的价值。
Objective To investigate the relationship between different types of hemorrhagic transformation and serum uric acid in patients with acute cerebral infarction.Methods The clinical data of 365 patients with acute cerebral infarction in Jinhua Central Hospital of Zhejiang Province from June 2018 to December 2020 were retrospectively analyzed.The clinical data and the serum uric acid level at the time of admission were recorded,and the occurrences of hemorrhagic infarction(HI)and cerebral parenchymal hematoma(PH)were counted.The risk factors of HI and PH in patients with acute cerebral infarction were analyzed by multivariate Logistic regression analysis.Results Among 365 patients,328 cases had no hemorrhagic transformation(control group);37 cases(10.1%)had hemorrhagic transformation,with 20 cases of HI(HI group)and 17 cases of PH(PH group).The uric acid in PH group was significantly lower than that in control group and HI group:(243.59±61.49)μmol/L vs.(307.84±80.12)and(305.45±94.99)μmol/L,and there was statistical difference(P<0.05);there was no statistical difference in uric acid between control group and HI group(P>0.05).The patients was divided into 3 groups according to the tertiles of serum uric acid,uric acid≤264.9μmol/L was in 121 cases(Ⅰgroup),265.0 to 338.8μmol/L was in 122 cases(Ⅱgroup)and≥338.9μmol/L was in 122 cases(Ⅲgroup).The rate of PH inⅢgroup was significantly lower than that inⅠgroup:0.8%(1/122)vs.8.3%(10/121),and there was statistical difference(P<0.05).Taking patients without hemorrhage transformation as a reference,multivariate Logistic regression analysis result showed that diabetes,atrial fibrillation and large-area infarction were independent risk factors of HI in patients with acute cerebral infarction(P<0.01);the age,large-area cerebral infarction,thrombolytic therapy,platelet count and uric acid were independent risk factors of PH in patients with acute cerebral infarction(P<0.05 or<0.01).Conclusions In patients with acute cerebral infarction,higher serum uric acid is independently correlated with lower PH,and has no correlation with HI.Serum uric acid level has certain value in predicting PH.
作者
袁晓波
傅亚明
郑水红
Yuan Xiaobo;Fu Yaming;Zheng Shuihong(Third Clinical College of Zhejiang Chinese Medical University,Hangzhou 310053,China;Second Department of Neurology,Jinhua Municipal Central Hospital,Zhejiang Jinhua 321000,China)
出处
《中国医师进修杂志》
2021年第11期1004-1009,共6页
Chinese Journal of Postgraduates of Medicine
关键词
脑梗塞
尿酸
出血转化
出血性脑梗死
脑实质血肿
Brain infarction
Uric acid
Hemorrhagic transformation
Hemorrhagic infarction
Parenchymal hematoma
作者简介
通信作者:郑水红,Email:zhengshuihong@126.com,电话:13738980136。
