Objective To analyze the influence of enlarged perivascular spaces (EPVS) on spontaneous hemorrhagic transformation (HT) of cerebral infarction. Methods The clinical data of 412 patients with acute ischemic stroke who were treated in Nanhai Hospital of Southern Medical University during Dec. 2014 to Dec. 2016 were collected. Based on the magnetic resonance imagine (MRI) results, the patients were divided into two groups: with EPVS groups and without EPVS groups. Baseline characteristics, the occurrence of HT were compared. Single factor and multi-factors analysis were made to show the factors that were significantly associated with EPVS. Then, the patients were divided into two groups: with HT groups and without HT groups. Single factor and multi-factors logistic regression analysis were made to study on EPVS and various kinds of risk factors as well as the influence demographic characteristics on HT in patients with ischemic stroke. Results The baseline data comparison showed, compared to patients without EPVS, patients with EPVS were older, more likely with the history of stroke, more likely with leukoaraiosis and more likely with HT. Single factor analysis showed that there were significant difference in age, stroke recurrence, leukoaraiosis and HT. Multi-factors logistic regression analysis showed that HT and leukoaraiosis were significantly associated with EPVS. The analysis of HT showed that there were significant difference in arterial fibrillation, uses of anticoagulant drug, EPVS, large size of infraction,uric acid level and activated partial thromboplastin time (APTT), and EPVS, size of infraction and APTT level were risk factors for HT.%目的 分析扩大的血管周围间隙对脑梗死自发性出血转化的影响.方法 分析南方医科大学附属南海医院2014年12月-2016年12月的412例脑梗死患者,将脑梗死患者按颅脑磁共振成像(magnetic resonance imaging,MRI)结果分为有扩大的血管周围间隙(enlarged perivascular spaces,EPVS)组及无EPVS组,比较两组患者的基线特点和颅内出血转化的发生率,通过单因素及多因素分析发现与EPVS相关的因素.将患者分为发生出血转化组(hemorrhagic transformation, HT)和无HT组,分别通过单因素及多因素Logistic回归分析研究EPVS及各危险因素、人口统计学特征对脑梗死患者自发性出血性转化的影响.结果 两组患者的基线资料比较显示,有EPVS组的患者年龄较无EPVS组高,脑白质变性发生率、出血转化的发生率较高,单因素分析显示两组之间年龄、复发卒中、脑白质变性、出血转化之间的差异有显著性,多因素Logistic回归分析显示脑白质变性、出血性转化与EPVS相关.针对HT进行分组的分析结果如下:单因素分析显示心房颤动、抗凝药物使用、EPVS、大面积脑梗死、血尿酸水平、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)水平差异有显著性;多因素Logistic回归分析显示EPVS、梗死面积、APTT水平是影响脑梗死患者自发性出血性转化的危险因素.结论 EPVS与脑白质变性及出血转化相关,EPVS是影响脑梗死患者自发性出血转化的独立危险因素.
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