不同评估模型对于预测急性脑梗死患者rt-PA治疗后出血转化的价值分析  

Values of different evaluation models for predicting hemorrhagic transformation after rt-PA treatment in patients with acute cerebral infarction

作　　者：王亚萍 王娟[1] WANG Yaping;WANG Juan(Department of Emergency,Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430000,China)

机构地区：[1]华中科技大学同济医学院附属武汉市中心医院急诊科,武汉430000

出　　处：《临床急诊杂志》2018年第11期782-786,共5页Journal of Clinical Emergency

摘　　要：目的:探究不同评估模型预测急性脑梗死患者静脉溶栓治疗后出血转化的价值。方法:对我院2016-01—2017-12期间行rt-PA治疗的254位患者进行回顾性分析,以头颅CT检查为金标准,将患者分为无出血转化组(215例)和出血转化组(39例),对比两组GRASPS评分、MSS评分、HAT评分及STARTING-SICH评分的差异,使用受试者工作曲线评价上述不同模型预测出血转化的效能。结果:出血转化组各模型评分显著高于无出血转化组(t=4.840,-3.290,-3.282,-10.062;P=0.000,0.001,0.001,0.000);ROC曲线显示,STARTING-SICH评分、GRASPS评分、MSS评分及HAT评分预测HT发生的曲线下面积从大到小分别为0.903、0.683、0.647、0.602,其中STARTING-SICH评分预测效能显著高于其他3个评分(Z=4.902,4.568,5.481;P=0.000,0.000,0.000),GRASPS、HAT与MSS评分预测效能差异无统计学意义(Z=1.164,0.532,0.872;P=0.245,0.595,0.383),上述模型所得到最佳截点分别为34、78、1、2;MSS评分特异性显著优于STARTING-SICH、GRASPS及HAT评分(P<0.05);STARTING-SICH评分与GRASPS评分敏感性差异无统计学意义(P>0.05),且明显优于HAT及MSS评分(P<0.05)。结论:STARTING-SICH评分、GRASPS评分、MSS评分及HAT评分均具有较好预测梗死患者溶栓治疗后出血转化的效能,其中STARTING-SICH评分预测效能最高,且具有较高的特异性及敏感性。Objective:To explore the values of different evaluation models in predicting hemorrhagic transformation risks after intravenous thrombolysis with acute ischemic stroke.Method:A retrospective analysis of 254 patients who underwent rt-PA treatment between January 2016 and December 2017 was performed.The patients were divided into the non-bleeding group(215 cases)and the hemorrhagic transformation group(39 cases)according to the head CT examination as the gold standard.The differences in GRASPS scores,MSS scores,HAT scores,and STARTING-SICH scores were compared between the two groups.The receiver work curves were used to evaluate the efficacy of the above different models in predicting hemorrhagic transformation.Result:The scores of the models in the hemorrhagic transformation group were significantly higher than those in the non-bleeding group(t=4.840,-3.290,-3.228,-10.062;P=0.000,0.001,0.001,0.000).The ROC curve showed that the area under the curve of STARTING-SICH score,GRASPS score,MSS score and HAT score predicted HT was 0.903,0.683,0.647,0.602,respectively,and the STARTING-SICH score was significantly higher than the other three.The scores were(Z =4.902,4.568,5.481;P =0.000,0.000,0.000).There was no significant difference between GRASPS,HAT and MSS scores(Z=1.164,0.532,0.872;P=0.245,0.595,0.383).The best cutoff points obtained by the above models are 34,78,1,and 2,respectively.The MSS score specificity was significantly better than the STARTING-SICH,GRASPS and HAT scores(P <0.05).There was no significant difference between the STARTING-SICH score and the GRASPS score sensitivity(P >0.05),and it was significantly better than the HAT and MSS scores(P<0.05).Conclusion:The STARTING-SICH score,GRASPS score,MSS score and HAT score have a good predictive effect on hemorrhagic transformation after thrombolytic therapy in patients with infarction.The STARTING-SICH score has the highest predictive efficacy and high specificity and sensitivity.

关 键 词：出血转化 脑梗死STARTING-SICH评分GRASPS评分 MSS评分 HAT评分 

分 类 号：R743.33[医药卫生—神经病学与精神病学]