进展性脑梗死患者应用阿加曲班后出血的危险因素分析及风险预测模型构建  

Analysis of risk factors and establishment of risk prediction model for hemorrhage induced by argatroban in patients with progressive cerebral infarction

作　　者：马胜男 张建红[1] 史海雯[1] 李昌军[1] 王洪新[2] MA Shengnan;ZHANG Jianhong;SHI Haiwen;LI Changjun;WANG Hongxin(Department of Pharmacy,Tianjin Fourth Central Hospital,Tianjin 300140,China;不详)

机构地区：[1]天津市第四中心医院药剂科,天津300140 [2]天津市第四中心医院神经病学中心

出　　处：《山东医药》2022年第22期6-10,共5页Shandong Medical Journal

基　　金：天津市卫生局科技基金资助项目(ZC20109);天津市第四中心医院优秀青年人才培养基金项目(tjdszxyy20210023)。

摘　　要：目的探讨进展性脑梗死患者应用阿加曲班后出血的危险因素,并构建其风险预测模型。方法选择216例应用阿加曲班治疗的进展性脑梗死患者,按照是否发生出血分为出血者和未出血者,采用单因素分析明确可能引起出血的危险因素,进一步通过多因素Logistic回归分析构建出血风险因素预测模型。结果216例患者中,39例(18.06%)治疗后发生出血,其中大出血4例(10.3%),小出血35例(89.7%)。多因素回归分析结果显示,BMI、48 h内是否应用过抗凝药物、是否接受过脑血管介入治疗、入院血糖是阿加曲班治疗后出血的影响因素。进一步得到出血风险联合预测因子Y=-0.206-2.042_(XBMI(1))-2.459XBMI(2)-1.677_(XBMI(3))+2.775X_(48h内是否应用过抗凝药物)-2.673X_(是否接受过脑血管介入治疗)+0.102X_(入院血糖),其受试者工作特征曲线的曲线下面积为0.738。结论低BMI、入院血糖偏高、联合应用抗凝药物及未接受过脑血管介入治疗的进展性脑梗死患者应用阿加曲班治疗后出血概率更高,由此构建的模型有较好预测能力,可对进展性脑梗死中应用阿加曲班发生出血的高危人群进行有效识别。Objective To explore the risk factors of hemorrhage induced by argatroban in patients with progressive cerebral infarction and to establish a risk prediction model.Methods Totally 216 inpatients treated with argatroban due to progressive cerebral infarction were divided into the bleeding group and non-bleeding group according to whether hemor⁃rhage occurred or not.Univariate analysis was used to identify risk factors for bleeding,and then we established a risk pre⁃diction model of bleeding by multivariate Logistic regression analysis.Results Among 216 patients,bleeding occurred in 39 cases(18.06%)after treatment,including massive bleeding(10.3%)and minor bleeding(89.7%).The results of multivariate Logistic regression analysis demonstrated that BMI,whether the anticoagulants were used within 48 h,wheth⁃er cerebrovascular intervention therapy was received,and the admission blood glucose were independent influence factors for bleeding after argatroban treatment.Further,the combined predictor Y was obtained(Y=-0.206-2.042_(XBMI(1))-2.459_(XBMI(2))-1.677_(XBMI(3))+2.775X_(whether anticoagulants were used)-2.673X _(whether cerebrovascular intervention therapy was received)+0.102X_( admission glucose)),and the area under the receiver operating characteristic(ROC)curve(AUC)was 0.738.Conclusions The progressive cere⁃bral infarction patients with low BMI,high blood glucose at admission,combined use of anticoagulants,and no cerebral vascular intervention have a higher bleeding probability after applying argatroban.The model constructed in this study has a good predictive ability,which can effectively identify the patients at high risk of bleeding induced by argatroban treat⁃ment from patients with progressive cerebral infarction.

关 键 词：进展性脑梗死 出血 阿加曲班 风险因素 

分 类 号：R742[医药卫生—神经病学与精神病学]