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目的探讨脑梗死出血性转化(hemorhagic transformation,HT)的发病机制及相关危险因素。方法分析36例脑梗死出血性转化患者临床和神经影像学资料。在发病21d内复查头部CT或MRI,分为出血性梗死(hemorrhagic infarction,HI)21例和脑实质血肿(parenchymal hematoma,PH)15例。将这二种分为四型,HI1、HI2、PH1和PH2,根据美国国立卫生研究院脑卒中量表(NIHSS)对患者于病初及出院时各评分1次,以第二次评分减少作为脑功能改善的指标。结果 HI1、HI2型患者入院时及出院时NIHSS评分差异有统计学意义(P<0.01);PH1、PH2型患者入院时及出院时NIHSS评分差异无统计学意义(P>0.05)。结论 HT的发生是多因素、多机制共同作用的结果。大面积脑梗死,应用溶栓、抗凝、降纤及抗聚治疗,高胆固醇血症及心房颤动史是HT的主要危险因素。
Objective To investigate the pathogenesis and related risk factors of hemorhagic transformation (HT) in cerebral infarction. Methods Clinical and neuroimaging data of 36 patients with hemorrhagic transformation of cerebral infarction were analyzed. The head CT or MRI were reviewed within 21 days of onset, and were divided into 21 cases of hemorrhagic infarction (HI) and 15 cases of parenchymal hematoma (PH). The two groups were divided into four groups, HI1, HI2, PH1 and PH2. Patients were scored 1 at the beginning and at the time of discharge according to the National Institutes of Health Stroke Scale (NIHSS) Indicators of brain function improvement. Results The NIHSS scores at admission and at discharge from HI1 and HI2 patients were significantly different (P <0.01). There were no significant differences in NIHSS scores between admission and discharge at PH1 and PH2 (P> 0.05). Conclusion The occurrence of HT is the result of multi-factor and multi-mechanism cooperation. Large area cerebral infarction, thrombolysis, anticoagulation, fibrinolysis and anti-agglomeration therapy, hypercholesterolemia and atrial fibrillation history are the main risk factors for HT.