急性缺血性脑卒中静脉阿替普酶溶栓后出血转化的危险因素及预测模型Risk factors and prediction models of hemorrhagic transformation after intravenous alteplase thrombolysis in acute ischemic stroke
罗晴蓉;李运飞;边林;张丽芳;
摘要(Abstract):
阿替普酶(重组组织型纤溶酶原激活剂,rt-PA)静脉溶栓是目前国内外医治急性缺血性脑卒中(acute ischemic stroke,AIS)最有效的方法之一,其临床疗效已得到广泛验证,然而溶栓后继发出血转化(hemorrhagic transformation,HT)是其并发症之一,严重影响治疗效果及预后。溶栓后HT由多种危险因素引起,国内外很多学者和团队针对可能影响HT的危险因素进行了研究,并且建立了一系列预测模型预测静脉溶栓后HT的风险。本文就rt-PA静脉溶栓后继发HT的病变机制、危险因素及预测模型作一综述。
关键词(KeyWords): 缺血性脑卒中;静脉溶栓;出血转化;危险因素;预测模型
基金项目(Foundation): 山西省卫生计生委科研项目(编号:201602027)
作者(Authors): 罗晴蓉;李运飞;边林;张丽芳;
参考文献(References):
- [1] WANG W,JIANG B,SUN H,et al.Prevalence,Incidence,and Mortality of Stroke in China:Results from a Nationwide Population-Based Survey of 480 687 Adults[J].Circulation,2017,135(8):759-771.
- [2] 常建军,李浩,李春生,等.阿替普酶静脉溶栓治疗急性脑梗死及出血转化的影响因素[J].中国实用神经疾病杂志,2019,22(9):948-953.
- [3] áLVAREZ-SABIN J,MAISTERRA O,SANTAMARINA E,et al.Factors influencing haemorrhagic transform-ation in ischaemic stroke[J].LancetNeurol,2013,12(7):689-705.
- [4] CHEN G,WANG A,ZHAO X,et al.Frequency and risk factors of spontaneous hemorrhagic transformation following ischemic stroke on the initial brain CT or MRI:data from the China National Stroke Registry (CNSR)[J].Neurol Res,2016,38(6):538-544.
- [5] DEL-ZOPPO G J.Stroke and neurovascular protection[J].N.Engl.J.Med,2006,354(6):553-555.
- [6] YAMASHITA T,KAMIYA T,DEGUCHI K,et al.Dissociation and protection of the neurovascular unit after thrombolysis and reperfusion in ischemic rat brain[J].JCerebBlood Flow Metab,2009,29(4):715-725.
- [7] MIZUMA A,YENARI M A.Anti-Inflammatory Targets for the Treatment of Reperfusion Injury in Stroke[J].Front Neurol,2017,8(7):467.
- [8] BAI J,LYDEN PD.Revisiting cerebral postischemic reperfusion injury:new insights in understanding reperfusion failure,hemorrhage,and edema[J].Int J Stroke,2015,10(2):143-152.
- [9] VANDELLI L,MARIETTA M,GAMBINI M,et al.Fibrinogen decrease after intravenous thrombolysis in ischemic stroke patients is a risk factor for intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2015,24(2):394-400.
- [10] SOMMER C J.Ischemic stroke:experimental models and reality[J].Acta Neuropathol,2017,133(2):245-261.
- [11] LODDER J,KRIJNE-KUBAT B,BROEKMAN J.Cerebral hemorrhagic infarction at autopsy:cardiac embolic cause and the relationship to the cause of death[J].Stroke,1986,17(4):626-629.
- [12] FISHER M,ADAMS R D.Observations on brain embolism with special reference to the mechanism of hemorrhagic infarction[J].J Neuropathol Exp Neurol,1951,10(1):92-94.
- [13] WHITELEY W N,SLOT K B,FERNANDES P,et al.Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator:a systematic review and meta-analysis of 55 studies[J].Stroke,2012,43(11):2904-2909.
- [14] KANG D H,YOON W.Current Opinion on Endovascular Therapy for Emergent Large Vessel Occlusion Due to Underlying Intracranial Atherosclerotic Stenosis[J].Korean Jradiol,2019,20(5):739-748.
- [15] 王彩玲,冯娟.急性脑梗死静脉溶栓后继发出血转化的危险因素及预测模型分析[J].中国医师杂志,2019,21(4):540-543.
- [16] YU Y,ZHANG F L,QU Y M,et al.Intracranial Calcification is Predictive for HemorrhagicTransformation and Prognosis After Intravenous Thrombolysis in Non-Cardioembolic Stroke Patients[published online ahead of print,2020 Jun 27][J].J Atheroscler Thromb,2020,10:5551.
- [17] WANG R,ZENG J,WANG F,et al.Risk factors of hemorrhagic transformation after intravenous thrombolysis with rt-PA in acute cerebral infarction[J].QJM,2019,112(5):323-326.
- [18] GE WQ,CHEN J,PAN H,et al.Analysis of Risk Factors Increased Hemorrhagic Transformation after Acute Ischemic Stroke[J].JStroke Cerebrovasc Dis,2018,27(12):3587-3590.
- [19] SZEGEDI I,NAGY A,SZEKELY E G,et al.PAI-1 5G/5G genotype is an independent risk of intracranial hemorrhage in post-lysis stroke patients[J].Ann Clin Transl Neurol,2019,6(11):2240-2250.
- [20] EI NAWAR R,YEUNG J,LABREUCHE J,et al.MRI-Based Predictors of Hemorrhagic Transformation in Patients With Stroke Treated by Intravenous Thrombolysis[J].Front Neurol,2019,10:897.
- [21] 刘勇林,卢节开,王雅芝,等.不对称皮层血管征预测急性脑梗死静脉溶栓后出血转化[J].中国实用神经疾病杂志,2019,22(21):948-953.
- [22] LOU M,SAFDAR A,MEHDIRATTA M,et al.The HAT Score:a simple grading scale for predicting hemorrhage after thrombolysis[J].Neurology,2008,71(18):1417-1423.
- [23] CUCCHIARA B,TANNE D,LEVINE S R,et al.A risk score to predict intracranial hemorrhage after recombinant tissue plasminogen activator for acute ischemic stroke[J].J Stroke Cerebrovasc Dis,2008,17(6):331-333.
- [24] MAZYA MV,BOVI P,CASTILLO J,et al.External validation of the SEDAN score for prediction of intracerebral hemorrhage in stroke thrombolysis[J].Stroke,2013,44(6):1595-1600.
- [25] MAZYA M,EGITO J A,FORD G A,et al.Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase:safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score[J].Stroke,2012,43(6):1524-1531.
- [26] MENON BK,SAVER J L,PRABHAKARAN S,et al.Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator[J].Stroke,2012,43(9):2293-2299.
- [27] SAPOSNIK G,KAPRAL M K,LIU Y,et al.IScore:a risk score to predict death early after hospitalization for an acute ischemic stroke[J].Circulation,2011,123(7):739-749.
- [28] FLINT A C,CULLEN S P,FAIGELES B S,et al.Predicting long-term outcome after endovascular stroke treatment:the totaled health risks in vascular events score[J].AJNR Am J Neuroradiol,2010,31(7):1192-1196.
- [29] FLINT A C,FAIGELES B S,CULLEN S P,et al.THRIVE score predicts ischemic stroke outcomes and thrombolytic hemorrhage risk in VISTA[J].Stroke,2013,44(12):3365-3369.
- [30] SAPOSNIK G,GUZIK A K,REEVES M,et al.Stroke Prognostication using Age and NIH Stroke Scale:SPAN-100[J].Neurology,2013,80(1):21-28.
- [31] CAPPELLARI M,TURCATO G,FORLIVESI S,et al.STARTING-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Intravenous Thro-mbolysis for Stroke[J].Stroke,2018,49(2):397-404.
- [32] LOKESKRAWEE T,MUENGTAWEEPONGSA S,PATUMANOND J,et al.Prediction of Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke:The Symptomatic Intracranial Hemorrhage Score[J].J Stroke Cerebrovasc Dis,2017,26(11):2622-2629.
- [33] 王闯,于正涛,陈伟明.脑梗死静脉溶栓后颅内出血风险列线图预测模型建立[J].中国神经精神疾病杂志,2019,45(8):449-453.
- [34] NISAR T,HANUMANTHU R,KHANDELWAL P.Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis:Predictive Factors and Validation of Prediction Models[J].J Stroke Cerebrovasc Dis,2019,28(11):104360.
- [35] VAN HOOFF R J,NIEBOER K,DE SMEDT A,et al.Validation assessment of risk tools to predict outcome after thrombolytic therapy for acute ischemic stroke[J].Clin Neurol Neurosurg,2014,125(11):189-193.
- [36] SUNG S F,LIN H J,CHEN C H.Response to letter by Siegler and Martin-Schild regarding article,"Comparison of risk-scoring systems in predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis"[J].Stroke,2013,44(8):e98.