静脉血栓栓塞包括深静脉血栓和肺栓塞，是卒中后常见的、可致命性的并发症。与脑梗塞相比，目前临床上脑出血主要是支持治疗，尚缺乏有循证医学证据支持的治疗手段。VTE有可能成为降低脑出血死亡率、改善预后的一个“新靶点”。基于前期中国国家卒中登记数据库，我们发现一个有趣的现象：“脑出血较急性脑梗塞增加VTE的发生风险1.6倍”。同时，我们提出“急性脑出血较脑梗塞增加静脉血栓栓塞事件风险”的三部曲理论假设，即不同类型的血管事件，继发血凝系统功能的不同改变，最终导致VTE风险的差异。本研究中，申请者利用已经建立的脑卒中住院并发症前瞻性队列，拟通过对比脑出血和脑梗塞后不同时点内皮细胞功能、血小板聚集功能、凝血和抗凝功能、纤溶和抗纤溶功能的差异，以揭示这一临床现象的血凝相关分子机制。该研究不仅有利于我们深入认识急性卒中后VTE发生、发展的规律，更为探索降低脑出血死亡率、改善脑预后提供新的治疗理念和干预靶点。

Venous thromboembolism is a common, fateful, and preventable complication in stroke patients. Venous thromboembolism encompasses both deep vein thrombosis and pulmonary embolism. The incidence of venous thromboembolism among patients with stroke is high, and pulmonary embolism remains the third-highest cause of case fatality in stroke. Despite advances in medical knowledge, treatment for intracerebral hemorrhage remains strictly supportive with not many evidence-based interventions currently available and prophylaxis and treatment of venous thromboembolism could be new target for decreasing intracerebral hemorrhage related mortality and morbidity. This study was based on the largest stroke registry in China, the China National Stroke Registry (CNSR), which is a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events. A total of 132 hospitals which cover 27 provinces and 4 municipalities across China were enrolled in the CNSR during 2007 and 2008. Based on the CNSR, we found an interesting clinical phenomenon: after adjusting potential confounders, intracerebral hemorrhage could increase the risk of developing in-hospital venous thromboembolism compared with that after acute ischemic stroke (OR=1.65；95% CI=1.16-2.36；P=0.006). Meanwhile, we make a theoretical hypotheses on this phenomenon, namely, different cerebral vascular events (hemorrhagic vs. ischemic stroke) would cause different secondary changes of coagulation system (coagulation vs. fibrinolytic hyper-function), which finally decide the different (increased vs. decreased) risk of developing venous thromboembolism after onset. In the study, based on an establish cohort of in-hospital medical complications after acute stroke, the applicants aim to investigate the underlying molecular mechanisms of the phenomenon by comparing the function of endothelial cell, platelet, coagulation system, and fibrinolytic system at different time (6 hours, 24 hours, 3 days and 7 days) after acute ischemic stroke and intracerebral hemorrhage. Theoretically, the study could give us more important findings on how the different risk of developing venous thromboembolism after acute ischemic stroke and intracerebral hemorrhage. Practically, the study could provide us novel notions, targets and methods for prevention and management of venous thromboembolism after intracerebral hemorrhage, as might be new ways for decreasing intracerebral hemorrhage related mortality and morbidity in clinical practice.

静脉血栓栓塞包括深静脉血栓形成和肺栓塞，是卒中后常见的、可致命性的并发症；静脉血栓栓塞(venous thromboembolism, VTE)包括深静脉血栓形成(deep venous thrombosis，DVT)和肺血栓栓塞 (pulmonary embolism，PE)两种形式。以往，国际上关于卒中后VTE的研究，主要是在脑梗塞或脑出血等单一血管事件亚型队列中进行。目前，国际上尚无关于脑梗塞和脑出血后VTE发生风险差异的研究报道。基于中国国家卒中登记数据库，我们发现了一个有趣的现象：对于肢体瘫痪程度相当的急性脑梗塞和脑出血患者，其发生VET的风险存在明显差异，脑出血后VTE的发生风险较脑梗塞增加1.6倍。本研究基于前瞻性队列对别分析不同卒中亚型深静脉血栓形成的发生风险。本研究发现脑梗死、脑出血和蛛网膜下腔出血自发病至深静脉血栓形成时间的中位数分别为10.5 days (IQR: 3.8-14.5), 7.5 days (IQR:4.0-9.5)和 7.0 days (IQR:5.0-12.5)。脑梗死、脑出血和蛛网膜下腔出血住院深静脉血栓发生比例分别为1.9%, 5.7% 和 7.9%。脑出血(5.7% vs. 1.9%; P<0.001)和蛛网下腔出血(7.9% vs. 1.9%; P<0.001)住院深静脉血栓发生比例明显高于脑梗死。矫正所有可能的混杂因素后，脑出血(OR=7.350; 95% CI=2.411-22.13; P<0.001)和蛛网下腔出血(OR=11.92; 95% CI=5.192-27.38; P<0.001)住院深静脉血栓发生比例明显高于脑梗死。 我们假设，不同的卒中亚型（急性脑梗塞和脑出血）继发了不同的内源性血凝系统功能的改变（纤溶亢进或凝血亢进），从而导致卒中后VTE发生风险的差异——即卒中后VET发生三部曲（不同卒中亚型，继发血凝系统功能不同改变，最终导致VTE发生风险的差异）。揭示急性脑出血和脑梗塞后VTE形成风险差异的理论和现实意义。与脑梗塞相比，目前临床上脑出血更多的是支持治疗，尚缺乏有效的循证医学证据支持的治疗手段。VTE作为脑出血后一个常见的、致命性、可预防的并发症，有可能成为降低脑出血相关死亡率、改善脑出血患者预后的一个“新靶点”。对“急性脑出血较脑梗塞增加VTE发生风险”这一临床发现的深入研究，并揭示其潜在的病