Risk Factors Related to Hemorrhagic Transformation′s Patients with Acute Cerebral Infarctions
|School||Dalian Medical University|
|Keywords||Cerebral infarction Hemorrhagic transformation Related-risk factors|
Background and purpose:Cerebrovascular disease can be briefly defined as an acute or chronic focal neurological deficit resulting from various vascular disease ,in which, stroke is a focal (or global) of brain impairment syndrome or also known as acute cerebrovascular events caused by acute cerebral circulation disorder . And the most common kind of cerebrovascular disease is seen as cerebral infarction which is caused by cerebral circulatory barrier and may lead to cerebral ischemia or hypoxic necrosis as well as acorresponding cerebral function disturbance. Hemorrhagic infarction, the term initially launched by Fisher and Adams in 1951,is the special type of cerebral infarction. Nowadays ,with the launching of anticoagulant therapies as well as the widespread of CT and MRI ,the reports of hemorrhagic infarction increased, which is also catching wide attention in clinic. There also exist lots of clinical evidence showed that part of HT patients may appear neurological deterioration and even death. In order to distinguish the different causes of HI ,without any interventions just firstly detected by CT or caused after drugs and others interventions used, neurologists specially used the term as hemorrhagic transformation. Hemorrhagic transformation(HT) referring to secondary hemorrhage after cerebral infarction is one of most common complications of acute cerebral ischemic stroke. The brain tissue ischemic necrosis of multiple bleeding points or sheet which can also integrated with each other to form varying hemorrhage sizes and the coexistence of hemorrhage and edema around the hemorrhagic transformation zone are the basic pathological changes of HT. The occurrence of hemorrhagic transformation is differ from different reports. It was considered that the proportion of HT to the total cerebral infarction was 3%-5%.While, some researchers using CT tracing patients after cerebral infarction showed that the proportion was raising to 18%-20%.Further more, in 1984,a pathological report from Calamde revealed that the proportion was raising highly up to 80% and most HT happened from cardiogenic cerebral embolism. While,the main mechanism of HT is still not well studied yet. There are many factors may involved in HT,such as cerebral embolism,infarction size,blood pressure changes and blood lipid abnormal. Therefore, to profoundly discuss the relationship of HT and these relevant factors upon may bring considerable help for HT in clinical.Methods:A total of 230 subjects (containind 30 subjects of HT) of acute cerebral infarction were enrolled after informed consent in the study from January 2009 to December 2010 in General Hospital of Shenyang Military Region Neurology department.candidate covariates for HT occurrence among acute cerebral infarction related to subject (gender、age、smoking、alcohol consumption、blood pressure、blood lipid、blood glucose、infarct size、embolic infarction and other clinical data) were analyzed by using one-way analysis.And the selected relevant factors of HT were then analyzed by using Logistic transformation analysis.Results:Of candidate covariates, relating to subject (gender、age、smoking、alcohol consumption、blood pressure、blood lipid、blood glucose、infarct size、embolic infarction and other clinical data), only embolic infarction,infarct size,triglyceride,high density lipoprotein,systolic blood pressure level and length of hospital staying had a significant effect(P<0.05).Then performance measures were preadjusted for relevant characteristics:embolic infarction(p=0.048),infarct size(p=0.000),triglyceride(p=0.029), high density lipoprotein(p=0.008),systolic blood pressure level(p=0.012) and length of hospital staying(p=0.003) by using Logistic transformation analysisConclusion:After univariate analysis and logistic regression analysis,this study showed that infarct size、cerebral embolism、systolic blood pressure、triglyceride、high density lipoprotein、hospital day are HT-related factors.Thus,acute cerebral infarction patients present those HT-related factors should be paid close attention for preventing the occurrence of HT and improving the patients’ prognosis.