Stroke:原发性脑出血后肝纤维化指标与患者结局

2020-01-07 xing.T MedSci原创

由此可见,在肝生化基本正常的患者中,2个肝纤维化指数与入院血肿体积、血肿扩大和脑出血后死亡率相关。

肝硬化(临床上明显的晚期肝病)与出血性卒中的风险增加和较差的卒中结局有关。近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员试图调查亚临床肝病,特别是肝纤维化,是否与原发性脑出血患者的临床和影像学结果相关。

研究人员使用虚拟国际卒中试验档案库中的数据进行了一项回顾性队列研究,研究人员纳入了在症状发作6小时内出现原发性脑出血的成年患者,并计算了3个经过验证的纤维化指数-天冬氨酸转氨酶-血小板比率指数、纤维化-4得分和非酒精性脂肪肝疾病纤维化得分-并将它们作为连续暴露变量建模。该研究的主要结局为入院血肿体积和血肿扩大情况。该研究的次要结局是死亡率,以及90天时主要残疾或死亡的综合事件。研究人员使用调整了既往已知的危险因素的线性和Logistic回归模型进行分析。

在432例脑出血患者中,入院时平均天门冬氨酸转氨酶-血小板比率指数、纤维化4得分和非酒精性脂肪肝纤维化评分值反映了纤维化的中等可能性,而标准的肝脏检查和凝血参数在很大程度上是正常的。在调整了可能的混杂因素后,天冬氨酸转氨酶-血小板比率指数与血肿体积(β,0.20 [95%CI,0.04-0.36])、血肿扩大(比值比,1.6 [95%CI,1.1-2.3])和死亡率(比值比为1.8 [95%CI,1.1-2.7])相关。纤维化4得分也与血肿体积(β,0.27 [95%CI,0.07-0.47])、血肿扩大(比值比为1.9 [95%CI,1.2-3.0])和死亡率(比值比为2.0 [ 95%CI,1.1–3.6])相关。非酒精性脂肪肝纤维化评分与任何预后无关。指数与严重残疾或死亡的综合因素无关。

由此可见,在肝生化基本正常的患者中,2个肝纤维化指数与入院血肿体积、血肿扩大和脑出血后死亡率相关。

原始出处:

Neal S. Parikh.et al.Liver Fibrosis Indices and Outcomes After Primary Intracerebral Hemorrhage.stroke.2019.https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.028161

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