| BackgroundWith the continuous development of the domestic economy,the living standards of the people are improving day by day.The incidence of diseases related to the improvement of the quality of life,such as cerebrovascular diseases,is also increasing year by year.Cardiogenic cerebral embolism(CCE)is one of the important types of ischemic stroke.Cardiogenic cerebral embolism is a type of stroke caused by thrombi from the heart.In recent years,studies have shown that cardiogenic cerebral embolism may be more common than large artery atherosclerosis stroke,the incidence of which accounts for about 20% of all types of cerebral infarction.Hemorrhagic transformation refers to the secondary hemorrhage in the infarct area.It is one of the common complications in the acute phase of ischemic stroke.It is also a common adverse reaction of thrombolysis,anticoagulant and anti-thrombotic therapy.Hemorrhagic transformation after stroke has been proved to be an important sign of poor prognosis in patients with ischemic stroke.The current clinical data shows that cardiogenic cerebral embolism is more prone to hemorrhagic transformation than other types of cerebral infarction,and most of the cardiogenic thrombi are caused byatrial fibrillation.In recent years,with the wild use of thrombolysis,anticoagulant and other treatments,the incidence of hemorrhagic transformation is higher than before,and the occurrence of hemorrhagic transformation undoubtedly increases the difficulty of clinical treatment.Cardiogenic cerebral embolism is one of the diseases with high incidence of hemorrhagic transformation in all types of neurology diseases.It is of great significance to explore the risk factors of hemorrhagic transformation after cardiogenic cerebral embolism and its influences on prognosis in order to improve the survival rate and living standard of patients.Purpose1.To investigate the clinical characteristics and related risk factors of cerebral embolism patients with hemorrhagic transformation caused by atrial fibrillation(AF).2.To analyze the relationship between the risk factors of hemorrhagic transformation and prognosis in cerebral embolism patients caused by atrial fibrillation(AF).MethodThe data of 160 patients with atrial fibrillation complicated with cerebral embolism admitted to the Second Affiliated Hospital of Zhengzhou University,the Fifth Affiliated Hospital of Zhengzhou University and the Zhengzhou Second Hospital from April 2015 to June 2018 were collected.According to whether hemorrhagic transformation(HT)occurred or not,they were divided into group A(HT after cerebral embolism)and group B(no HT after cerebral embolism).The medical history,the random blood glucose at admission,homocysteine level,the absolute value of neutrophils and lymphocytes in peripheral blood,infarct size and baseline HAS-BLED score at admission were collected.The baseline level of NIHSS score and mRS score at admission,1 month and 6 months after onset were collected and analyzed.All data of the two groups were analyzed by univariate and multivariate Logistic regression analysis.The prognosis of the two groups at different time points were evaluated and analyzed with NIHSS score and mRS score.The correlationbetween NLR and NIHSS score and mRS improvement rate was analyzed by Pearson correlation analysis.Result1.Of the 160 patients in the group,47 cases were found to have hemorrhagic transformation and 113 cases had no sign of hemorrhagic transformation on imaging.2.Univariate analysis showed that there were significant differences in infarct size,NIHSS score,HAS-BLED score,random blood glucose value and homocysteine level between the two groups(P<0.05).On this basis,further multivariate Logistic regression analysis showed that large infarct size,high HAS-BLED score and increase of random blood glucose at admission were independent risk factors for hemorrhagic transformation in patients with cerebral embolism caused by Atrial Fibrillation.3.The NIHSS score and mRS score of group A at different time were significantly higher than those of group B(P < 0.05).The improvement rate of mRS score in group A was lower than that in group B at 1 month and 6 month after onset,and the difference was significant(P < 0.05).4.In group A and B,NLR was positively correlated with NIHSS score at different time points,and negatively correlated with the improvement rate of mRS score at 1month and 6 months after onset,and the difference was significant(P < 0.05).Conclusion1.Large infarct size,high HAS-BLED score and increase of random blood glucose after admission are independent risk factors for hemorrhagic transformation in patients with cerebral embolism caused by atrial fibrillation.2.Hyperhomocysteinemia is a risk factor for hemorrhagic transformation in patients with cerebral embolism caused by atrial fibrillation,but it cannot be used as an independent predictor of hemorrhagic transformation.3.The occurrence of hemorrhagic transformation will affect the recovery of neurological function in patients with cardiogenic cerebral embolism,and results in a worse prognosis in them.4.NLR value can be used as a clinical index to evaluate the severity and prognosis of patients with cardiogenic cerebral embolism caused by atrial fibrillation,and has certain clinical value. |
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