中国实用神经疾病杂志2024，Vol.27Issue(3)：330-336,7.DOI:10.12083/SYSJ.231159
急性大血管闭塞性卒中机械取栓术后发生症状性颅内出血的预测模型建立
Predictive modeling of symptomatic intracranial hemorrhage after mechanical thrombectomy for acute ischemic stroke with large vessel occlusion
摘要
Abstract
Objective To analyze the factors influencing the occurrence of symptomatic intracranial hemorrhage(sICH)after mechanical thrombectomy for acute ischemic stroke with large vessel occlusion(AIS-LVO)and to develop a predictive model.Methods A total of 320 patients with AIS-LVO admitted to Dazhou Central Hospital for mechanical thrombectomy from January 2016 to December 2022 were selected and divided into sICH group and non-sICH group according to whether sICH occurred.Clinical data of patients with AIS-LVO were collected,and single-and multi-factor Logistic regression were used to analyze and develop predictive models for sICH after mechanical thrombectomy in patients with AIS-LVO,and the Hosmer-Lemeshow test was used to test the goodness of fit of the models.The value of receiver operating characteristic curve analysis prediction model to predict sICH after mechanical thrombectomy in patients with AIS-LVO.Results The incidence of sICH after mechanical thrombectomy in 320 patients with AIS-LVO was 24.06%(77/320).Univariate analysis showed that atrial fibrillation,cardiogenic embolic phenotype,baseline systolic blood pressure,baseline National Institutes of Health stroke scale(NIHSS)score,baseline diffusion-weighted imaging-Alberta stroke project early computed tomography score(ASPECTS),baseline blood glucose,baseline hemoglobin A1c(HbA1c),baseline neutrophil to lymphocyte ratio(neutrophil to lymphocyte ratio),baseline stroke scale,neutrophil to lymphocyte ratio(NLR),and baseline blood uric acid were factors influencing sICH after mechanical thrombectomy in patients with AIS-LVO(P<0.05).Multifactorial Logistic regression analysis showed that cardiogenic embolic phenotype,increased baseline NIHSS score,elevated baseline HbA1c,and increased baseline NLR were independent risk factors for sICH after mechanical thrombectomy in patients with AIS-LVO,and increased baseline ASPECTS score and elevated baseline blood uric acid were independent protective factors(P<0.05).Model equation for sICH after mechanical thrombectomy in patients with AIS-LVO:y=-4.246+0.674×cardiogenic embolic type+0.095×baseline NIHSS score-0.372×baseline ASPECTS score+0.852×baseline HbA1c+ 0.295×baseline NLR-0.008×baseline blood uric acid,P>0.05 by Hosmer-Lemeshow test.Analysis of the receiver operating characteristic curve showed that the area under the curve,sensitivity and specificity of the prediction model for predicting sICH after mechanical thrombectomy in AIS-LVO patients were 0.906,89.61%and 79.01%,respectively.Conclusion Cardiogenic embolic type,baseline NIHSS score,baseline ASPECTS score,baseline HbA1c,baseline NLR,and baseline blood uric acid are factors influencing sICH after mechanical thrombectomy in patients with AIS-LVO,and the prediction model based on these risk factors has a high predictive value for sICH after mechanical thrombectomy in patients with AIS-LVO.关键词
急性大血管闭塞性缺血性脑卒中/机械取栓术/症状性颅内出血/影响因素/预测模型Key words
Acute ischemic stroke with large vessel occlusion/Mechanical thrombectomy/Symptomatic intracranial haemorrhage/Influencing factors/Predictive model分类
医药卫生引用本文复制引用
刘月娥,陈俊霖,江学军..急性大血管闭塞性卒中机械取栓术后发生症状性颅内出血的预测模型建立[J].中国实用神经疾病杂志,2024,27(3):330-336,7.基金项目
四川省卫生健康委员会科研课题(编号:20PJ311) （编号:20PJ311）
