【摘要】 目的 探究急性颅内前循环大血管闭塞性缺血性脑卒中患者机械取栓（MT）术后出血转化（HT）的潜在危险因素，为减少取栓术后HT、改善患者预后提供科学依据。方法 本研究回顾分析了605例急性颅内前循环大血管闭塞性缺血性脑卒中（AIS-AC-LVO）患者数据。将患者临床数据资料进行Logistic回归分析，以P<0.05为差异有统计学意义，分析了机械取栓术后HT的独立预测因素。结果 本研究共纳入605例患者，MT术后发生HT的有207例（34.2%），未发生HT的有398例（65.8%）。通过统计分析，HT的独立预测因素是多次取栓（OR=1.340,P=0.003）、手术时间长（OR=1.005,P=0.024）、术前ASPECTS评分低（OR=0.798,P<0.001）、术后mTICI≤2a(OR=6.329,P=0.032)、术前血小板计数低（OR=0.995,P=0.008）、术前血糖高（OR=1.088,P=0.009）;68例（11.2%）患者发生了症状性颅内出血（sICH）。sICH的独立预测因素是房颤病史（OR=3.151,P=0.003）、术前ASPECTS评分低（OR=0.868,P=0.007）、手术时间延长（OR=1.009、P<0.001）、侧支循环不良（ASITN/SIR<2）(OR=2.307,P=0.035)、术前血小板计数低（OR=0.993,P=0.012）、术前D-二聚体水平高（OR=1.050,P=0.012）以及术前血糖水平高（OR=1.138,P=0.013）。结论 多次取栓、手术时间延长、术前ASPECTS评分低、术后mTICI≤2a、术前血小板计数低以及术前血糖水平高是HT的独立预测因素。房颤病史、术前ASPECTS评分低、手术时间延长、侧支循环不良（ASITN/SIR<2）、术前血小板计数低、术前D-二聚体水平高以及术前血糖水平高是sICH的独立预测因素。识别这些危险因素对于减少MT术后HT的发生、提高取栓治疗效果具有重要意义。更多还原

【Abstract】 Objective To investigate the potential risk factors for hemorrhagic transformation( HT) after mechanical thrombectomy( MT) in patients with acute ischemic stroke due to anterior circulation large vessel occlusion(AIS-ACLMVeO),thod as nd to provide a scientific evidence for reducing post-thrombectomy HT and improving the prognosis of patients.A retrospective analysis was performed for the data of 605 patients with AIS-AC-LVO. The Logistic regression analysis was performed for related clinical data to identify independent predictive factors for HT after MT, with a significance threshold of P<0. 05.Results A total of 605 patients were included in this study, among whom 207( 34. 2%) developed HT afterO MT, while 398( 65. 8%) did not experience HT. The statistical analysis showed that multiple attempts of thrombectomy( R=1. 340, P=0. 003), a prolonged time of operation( OR=1. 005, P=0. 024), a low ASPECTS score before surgery( OR=0. 798, P<0. 001), postoperative mTICI≤2a( OR=6. 329,OP P=0. 032), a low platelet count before surgery( R=0. 995, =0. 008), and a high level of blood glucose before surgery( OR=1. 088, P=0. 009) were independent predictive factors for HT. Symptomatic intracranial hemorrhage( sICH) was observed in 68 patients( 11. 2%), and a history of atrial fibrillation(OR=3. 151, P=0. 003), a low ASPECTS score before surgery(OR=0. 868, P=0. 007), a prolonged time of operation( OR=1. 009, P<0. 001), poor collateral circulation( ASITN/SIR<2)( OR=2. 307, P=0. 035), a low platelet count before surgery(OR=0. 993, P=0. 012), a high level of D-dimer before surgery(OR=1. 050, P=0. 012),C and a high level of blood glucose before surgery( OR=1. 138, P=0. 013) were independent predictive factors for sICH.onclusion Multiple attempts of thrombectomy, a prolonged time of operation, a low ASPECTS score before surgery, postoperative mTICI≤2a, a low platelet count before surgery, and a high level of blood glucose before surgery are independent predictive factors for HT. A history of atrial fibrillation, a low ASPECTS score before surgery, a prolonged time of operation, poor collateral circulation( ASITN/SIR<2), a low platelet count before surgery, a high level of D-dimer before surgery, and a high level of blood glucose before surgery are independent predictive factors for sICH. Identifying such risk factors is crucial for reducing HT after MT and improving the efficacy of thrombectomy.更多还原