| Cerebrovascular disease is a public health problem in the world and it is one of the three major causes of death.Hemorrhagic transformation(HT)is one of the natural outcomes of ischemic stroke in the ischemic cerebral infarction.According to Domestic and foreign research,the incidence of HT in patients with cerebral infarction is about 10% to 40% [1].Cerebral ischemia and hypoxia after vascular occlusion,vascular endothelial cell necrosis,destruction of the blood-brain barrier(BBB),occlusion of blood vessels,recanalization,or thrombolytic therapy.Ischemic cerebral tissue areas are reperfused and blood is leaked from the ruptured blood vessels.Blood-brain barrier damage caused brain tissue edema,increased intracranial pressure [2];HT has high mortality and morbidity,which attracted people’s attention.The European Collaborative Acute Stroke Study(ECASSII)classifies HT into four categories based on the imaging features: hemorrhagic transformation has been classified in the following different types : 1..hemorrhagic infarct type 1(HI1;small petechiae along the periphery of the infarct),2.hemorrhagic infarct type 2(HI2;confluent petechiae within the infarcted area without a space-occupying effect),3.parenchymal haematoma type 1(PH1;bleeding <30% of the infarcted area with a mild space-occupying effect),4.parenchymal haematoma type 2(PH2;bleeding >30% of the infarcted area with a significant spaceoccupying effect),and remote parenchymal hemorrhage [3];According to the degree of deterioration of neurological function,HT is divided into symptomatic group and non-symptomatic group.The research of Glen C.Jickling et al suggest.that even asymptomatic hemorrhagic transformation can worsen stroke outcome,especially cognitive impairment in stroke patients within weeks to months after stroke,which may be related to the deterioration of brain edema and the toxic effects of post-HT blood toxicity [ 4].Most of the HT occurred within 3 weeks after cerebral infarction,4 days to 2 weeks after cerebral infarction is considered to be the peak of hemorrhagic transformation after cerebral infarction [5];.Some patients with hemorrhagic cerebral infarction,especially PH type,have higher morbidity and mortality..Most people believe that the PH-2 type has a poor prognosis and is likely to have a disability or even death.PH-1,HI2 and HI1 have no significant effect on prognosis.At present,head CT and MRI technology have been widely used in clinical practice,which can improve the detection rate of HT,but it is not a routine review project after diagnosis or treatment of cerebral infarction.Therefore,hemorrhagic transformation without symptom aggravation is still easy to ignore.So it is important to know the early onset time,clinical symptoms,imaging findings and related risk factors of HT,which is helpful to find the hemorrhagic transformation in patients with acute cerebral infarction and take some measures in time,reduce the risk of bleeding after cerebral infarctionThe study reviewed retrospectively 58 hospitalized patients with HT in the first affiliated hospital of nanchang university neurology from October 2015 to March 2018,and 109 cases with acute cerebral infarction during the same period are chosed randomly as controls.The two groups are equal in age and gender.Collect relevant data,general situation: age,gender;past history: history of atrial fibrillation,history of stroke,diabetes,hypertension;clinical data: clinical symptoms,time of onset,infarct nature,clinical efficacy,and prognosis;laboratory test data: high Hyperhomocysteinemia(HHcy),triglycerides,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,INR,APTT;examination data: lesion location,lesion size,carotid plaque nature;treatment Methods: Antiplatelet aggregation or defibrillation therapy.SPSS19.0 statistical package is applied to process these datas.The qualitative datas are processed with χ2 test,and measurement dates are processed with t-test.each index is analyzed with univariate analysis,then statistically significant risk factors are included in the Logistic review model to conduct the multivariate regression analysis.Results: 1.The onset time of HT: less than 24 hours after infarction in 22 cases,1-3 days in 15 cases,4 to 7 days in 9 cases,8 to 15 days in 7 cases,a total of more than 15 days in 3 cases,three cases without clear time of hemorrhagic transformation.The longest was 60 days.Hemorrhagic transformation occurred within 7 days after infarction accounted for 79.3℅.2.HT-related risk factors: these factors increased the risk of hemorrhagic transformation in cerebral infarction such as cortical infarction,massive cerebral infarction,and cerebral embolism;History of atrial fibrillation,triglycerides,homocysteine may be related to HT.Those factors such as gender,age,history of cerebral infarction,high blood pressure,diabetes,onset time,APTT,INR,total cholesterol,high-density lipoprotein cholesterol(hdl-c),low density lipoprotein cholesterol(hdl-c),nature of carotid plaques have no correlation with HT.3.The clinical features of HT group:(1)15 cases with disturbance of consciousness,40 cases with hemiplegia,24 cases of aphasia,20 cases with headache dizziness,4 cases with visual disturbances,4 cases of facial paralysis,3 cases of numbness,3 cases with nausea and vomiting,2 cases with ataxia,1 case with directional force,memory dysfunction,1 case see things rotate;(2)in the HT group,17 cases with heavy symptom,41 cases with light symptoms,the subtypes of HT group,in the HI1 group,0 cases with heavy symptom,24 cases with light symptoms,in the HI2 group,4 cases with heavy symptom,15 cases with light symptoms,in the PH1 group,5 cases with heavy symptom,2 cases with light symptoms,in the PH2 group,8 cases with heavy symptom,0 cases with light symptoms;(3)the HT group of 30 cases with clinical symptom aggravating,accounted for 51.7℅,18 cases had no changes in clinical symptoms,10 cases were improved.3.In the HT group,the subtype HI1 is 43 cases,the subtype PH is 15 cases The subtype PH2 with clinical symptom aggravating had higher ratio of 46.7℅,compared with other subtypes,difference was statistically significant(P < 0.05),The efficiency of clinical treatment in PH-2 is 12.5%,while other three subtypes of PH-1,HI-2,HI-1 were 28.63%,73.7%,95.8% respectively.Conclusions:.1.HT mostly happen within 1 week after cerebral infarction.The changes of the patient’s condition should be closely observed within 1 week after acute cerebral infarction,and pay attention to review check of imaging.2.Cerebral embolism,cortical infarction and massive cerebral infarction are risk factors for HT,increasing the risk of hemorrhage transformation after cerebral infarction.Atrial fibrillation history,triglycerides,homocysteine are uncertain factors in HT.Fibrinolytic therapy should be carefully used for the patient with the above related risk factors,and pay attention to the review of head CT or MRI in the short term.3.The clinical symptom in HT patients are mainly hemiplegia,aphasia,disturbance of consciousness,The PH subtype mainly has a heavy clinical symptom,the HI subtype mainly has a light clinical symptom,the short-term prognosis of HT is related to the subtype.The subtype HI1 has the highest efficiency of clinical treatment and the best prognosis,subtype HI2 and subtype PH1 have a good prognosis,subtype PH2 has the lowest efficiency of clinical treatment and the worest prognosis,We should pay attention to the early imaging,combined with clinical symptoms and classification,timely adjust the treatment plans and take prevention measures. |
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