影响急性脑梗死患者静脉溶栓后出血性转化预后的危险因素分析  

Influencing Factors of Hemorrhagic Transformation Prognosis in Patients with Acute Cerebral Infarction after Intravenous Thrombolysis

作　　者：陈敏[1] 冯灵[1] 汪锐[1] 涂双燕[1] CHEN Min;FENG Ling;WANG Rui;TU Shuangyan(West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院,四川成都610041

出　　处：《北华大学学报（自然科学版）》2021年第5期639-643,共5页Journal of Beihua University（Natural Science）

基　　金：四川省科技发展计划项目(2020YFS0155);四川大学华西护理学科发展专项基金项目(HXHL20021).

摘　　要：目的探讨急性脑梗死(ACI)患者静脉溶栓后出血性转化(HT)的预后危险因素.方法回顾性分析150例急性脑梗死(ACI)患者资料,患者入院后均接受静脉溶栓治疗,且治疗后发生HT,依据改良Rankin量表评估患者预后(3个月)情况.收集患者各项资料,分析患者预后危险因素,并应用ROC曲线分析危险因素对患者预后的预测价值.结果预后良好组与预后不良组患者在房颤、抗凝药物应用、入院时NIHSS评分、血小板计数、梗死体积、HT位置等因素比较差异具有统计学意义(P<0.05);多因素Logistic回归分析显示:抗凝药物应用、入院时NIHSS评分以及HT位置是患者预后的危险因素(P<0.05),而房颤、血小板计数、梗死体积不是患者预后的危险因素(P>0.05);ROC曲线显示:抗凝药物应用、入院时NIHSS评分以及HT位置用于预测患者预后曲线下面积分别为0.602、0.770、0.592,各指标联合曲线下面积为0.801.结论抗凝药物应用、入院时NIHSS评分以及HT位置为ACI患者静脉溶栓后HT的预后危险因素,及时识别有利于患者的针对性治疗.Objective To explore the risk factors of hemorrhagic transformation(HT)prognosis in patients with acute cerebral infarction(ACI)after intravenous thrombolysis.MethodThe data of 150 patients with ACI were retrospectively analyzed.All underwent intravenous thrombolysis after admission,and there was HT after treatment.According to modified Rankin scale prognosis at 3 months after treatment was assessed.All data of patients were collected to analyze the risk factors of prognosis.The predictive value of risk factors for prognosis was analyzed by ROC curves.ResultsThere were significant differences between good prognosis group and poor prognosis group in atrial fibrillation,anticoagulants usage,scores of National Institutes of Health Stroke Scale(NIHSS)at admission,platelet count,infarct volume and HT sites(P<0.05).Multivariate Logistic regression analysis showed that anticoagulants usage,NIHSS score at admission and HT sites were risk factors of prognosis(P<0.05),while atrial fibrillation,platelet count and infarct volume were not risk factors of prognosis(P>0.05).ROC curve showed that area under the curve(AUC)values of anticoagulants usage,NIHSS score at admission and HT sites for predicting prognosis were 0.602,0.770 and 0.592,respectively.AUC of their combination was 0.801.ConclusionThe anticoagulants usage,NIHSS score at admission and HT sites are risk factors of HT prognosis in ACI patients after intravenous thrombolysis.Timely identification is conducive to targeted treatment for patients.

关 键 词：急性脑梗死 静脉溶栓 出血性转化预后 危险因素 

分 类 号：R743[医药卫生—神经病学与精神病学]