解放军医药杂志2016，Vol.28Issue(3)：26-32,7.DOI:10.3969/j.issn.2095-140X.2016.03.007
五种评分系统对急性缺血性脑卒中静脉溶栓后出血转化风险预测差异的比较研究
Comparative Analysis of Five Scoring Systems in Prediction of Hemorrhagic Transformation Risks after Intrave-nous Thrombolysis in Patients with Acute Cerebral Ischemic Stroke
摘要
Abstract
Objective To compare the value of five international scoring systems in prediction of hemorrhagic transformation ( HT) risks after intravenous thrombolysis in Chinese patients with acute ischemic stroke ( AIS) . Methods A single-center and retrospective study was performed for 262 AIS patients, who underwent intravenous thrombolysis u-sing recombinant tissue plasminogen activator (rt-PA) during January 2012 and December 2014. The HT risks were eval-uated using HAT model, MSS model, GRASPS model, SEDAN model and SITS model rating scales. The relationships between five scoring methods and HT incidence rate were observed;The predictive values of the five scoring systems were compared using the areas under the receiver operating characteristic ( ROC) curve;the correlation factors between indica-tors of five scoring systems and HT were analyzed using single factor analysis, and then the multivariate logistic regression analysis was performed for influencing factors with statistically significant differences. The item with statistically signifi-cant difference was considered to be an independent risk factor of HT after intravenous thrombolysis. Results HT inci-dence rate was increased with increasing scores of the five scoring systems. The chi-square test showed that HT rate differ-ences were statistically significance, and there were significant differences in chi-square tests of HT incidence rate among five scoring systems (P<0. 05);ROC area under the curve in the five scoring systems were more than 0. 5; results of pair comparison of the five scoring systems in the area under the ROC curve showed that GRASPA model was superior to those of MSS model and SITS model (P<0. 05);multivariate logistic regression analysis showed that age, early infarct signs by head computed tomography ( CT) upon admission, antiplatelet drug history and baseline NIHSS scores were HT independent risk factors of noncardiac cerebral embolisms by rt-PA intravenous thrombolysis using factors after excluding atria fibrillation factor in the single factor analysis (P <0. 05, P <0. 01). Conclusion HAT model, MSS model, GRASPS model, SEDAN model and SITS model can predict the HT risk after intravenous thrombolysis in Chinese AIS pa-tients. GRASPS model may have a relatively good predictive value. Clinicians should learn age, antiplatelet drug history, evaluation of early infarct signs by head computed tomography ( CT) upon admission and baseline NIHSS scores of pa-tients with noncardiac cerebral embolism by rt-PA intravenous thrombolysis so as to avoid HT.关键词
急性缺血性脑卒中/静脉溶栓/出血转化/危险因素Key words
Acute cerebral ischemic stroke/Intravenous thrombolysis/Hemorrhagic transformation/Risk factors分类
医药卫生引用本文复制引用
谷远峰,陈会生..五种评分系统对急性缺血性脑卒中静脉溶栓后出血转化风险预测差异的比较研究[J].解放军医药杂志,2016,28(3):26-32,7.基金项目
辽宁省科技攻关计划(2013225089,2014225008) （2013225089,2014225008）
