Study on the risk factors for hemorrhagic transformation of the different subtypes of acute cerebral infarction in elderly patients / 中华老年医学杂志

ABSTRACT

Objective To investigate the risk factors for hemorrhagic transformation(HT)of different subtypes of acute cerebral infarction in elderly patients.Methods A total of 415 elderly hospitalized patients aged ≥60 years with acute cerebral infarction were selected from a hospital in Changsha from January 2014 to December 2016 for the study.Among them,56 had hemorrhagic transformation(observation group)and 359 had no hemorrhage transformation(control group).The general demographic information,past medical history,physical examination and laboratory indicators,cranial CT/MRI examination,admission treatment and the National Institutes of Health Stroke Scale (NIHSS) score on admission were analyzed and compared between two different subtypes.Multivariate Logistic regression was used to analyze the influencing factors for HT of different subtypes of acute cerebral infarction in elderly patients.Results The incidence of HT was 26.61％(29/109)for largeartery atherothrombosis,47.50％ (19/40)for cardiac embolism and 3.12％ (8/257)for small-artery occlusion with a statistically significant differences among the three subtypes (x2 =77.923,P =0.000).The incidence of HT was 0％ (0/7)for unknown type,and 0％ (0/2)for other types.Multivariate logistic regression showed that female was the protective factor(OR =0.171,95％ CI:0.037-0.790),but high level of glycated haemoglobin A1c(HbA1c)and large infarct size were the risk factors(OR =5.949 and 20.619,95 ％CI:1.199-29.509 and 2.869-148.207)for HT due to largeartery atherothrombosis.A high score of NIHSS and high level of matrix metalloproteinase-9 (MMP-9)were the risk factors for HT due to cardioembolism(OR =20.254 and 91.200,95％CI:1.605-255.625 and 4.044-2056.710,respectively).A high level of homocysteine(Hcy) and large infarct size were the risk factors for HT due to small-artery occlusion(OR =10.231 and 15.251,95 ％ CI:1.202-87.108 and 3.371-68.995,respectively).Conclusions The incidence of HT due to cardioembolism is the highest.Influencing factors for HT due to different subtypes of acute cerebral infarction are different in the elderly.It is important for clinicians to know that gender,HbA1c levels and infarct size are associated with HT due to large-artery atherothrombosis,NIHSS score on admission and MMP-9 concentration associated with HT due to cardioembolism,and Hcy level and infarct size associated with HT due to small-artery occlusion.