急性脑梗死静脉溶栓后继发出血转化危险因素分析及预测模型构建  

Risk factors analysis and establishment of predictive model of secondary hemorrhagic transformation after intravenous thrombolysis in acute cerebral infarction

作　　者：李令培 马新安 张超[3] 江四清[1] 汤其强 LI Lingpei;MA Xin′an;ZHANG Chao;JIANG Siqing;TANG Qiqiang(Department of Neurology,Huaibei People′s Hospital,Huaibei 235000,Anhui Province,China;Department of Neurology,Huaibei Miners General Hospital,Huaibei 235000,Anhui Province,China;Department of Neurology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230031,Anhui Province,China)

机构地区：[1]淮北市人民医院神经内科,安徽淮北235000 [2]淮北矿工总医院神经内科,安徽淮北235000 [3]中国科学技术大学附属第一医院神经内科,安徽合肥230031

出　　处：《新乡医学院学报》2023年第4期366-370,共5页Journal of Xinxiang Medical University

摘　　要：目的探讨急性脑梗死静脉溶栓后继发出血转化(HT)的危险因素及预测模型。方法选择2018年1月至2021年6月于淮北市人民医院行静脉溶栓治疗的555例急性脑梗死患者为研究对象,根据患者治疗后是否继发HT分为HT组(n=35)和非HT组(n=520)。查阅2组患者的病历资料,统计患者的性别、年龄、心房颤动、体质量指数(BMI)、服用抗凝药物情况、是否吸烟、是否有高血尿酸、高血压、高脂血症以及美国国立卫生研究院卒中量表(NIHSS)评分和活化部分凝血活酶时间(APTT),对可能影响HT的因素进行单因素及多因素logistic回归分析。根据HT多因素logistic回归分析结果,应用R软件建立预测急性脑梗死静脉溶栓后继发HT的列线图预测模型;绘制受试者操作特征(ROC)曲线,分析该模型在急性脑梗死静脉溶栓后继发HT中的预测区分度,采用rms包绘制校准曲线,检验评估列线图模型的准确度。结果单因素及多因素logistic分析显示,急性脑梗死静脉溶栓治疗患者HT的发生与高血尿酸、高血压、高血脂、性别及BMI无关(P>0.05)。急性脑梗死静脉溶栓治疗患者HT的发生与年龄、心房颤动、服用抗凝药物、吸烟、APTT及NIHSS评分有关(P<0.05)。急性脑梗死静脉溶栓后继发HT的风险预测列线图模型显示,心房颤动得分为63.0分,服用抗凝药物得分为37.6分,APTT得分71.5分,NIHSS评分得分为60.0分,模型具有良好的区分度。列线图模型预测急性脑梗死静脉溶栓后继发HT的ROC曲线下面积为0.867,95%置信区间为0.785~0.931,校准图线图上列线图模型的校准曲线为斜率接近1的直线,列线图校准度良好。结论急性脑梗死静脉溶栓后继发HT发生率较高,影响因素较多,构建的预测模型具有较高的预测效能,区分度良好,能为临床预防急性脑梗死静脉溶栓后继发HT提供参考依据。Objective To investigate the risk factors and predictive model of secondary hemorrhagic transformation(HT)after intravenous thrombolysis in patients with acute cerebral infarction.Methods A total of 555 patients with acute cerebral infarction who received intravenous thrombolysis in Huaibei People′s Hospital from January 2018 to June 2021 were selected as the research subjects.The patients were divided into HT group(n=35)and non-HT group(n=520)according to whether they had secondary HT after treatment.The medical records of all patients were reviewed,and their gender,age,atrial fibrillation,body mass index(BMI),use of anticoagulants,smoking,hyperuricemia,hypertension,hyperlipidemia,National Institutes of Health Stroke Scale(NIHSS)score and activated partial thromboplastin time(APTT)were statically analyzed.The influence factor of HT was analyzed by univariate and multivariate logistic analysis.The nomogram prediction model for predicting secondary HT after intravenous thrombolysis in acute cerebral infarction was established by R software based on the results of multivariate logistic regression analysis.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive discrimination of the model in secondary HT of acute cerebral infarction after intravenous thrombolysis.The calibration curve was drawn by rms package to test and evaluate the accuracy of the nomogram model.Results Univariate and multivariate logistic analysis results showed that the occurrence of HT in patients with acute cerebral infarction treated with intravenous thrombolysis was not correlated with hyperuricemia,hypertension,hyperlipidemia,gender and BMI(P>0.05).The occurrence of HT in patients with acute cerebral infarction after intravenous thrombolysis was related to the age,atrial fibrillation,taking anticoagulant drugs,smoking,APTT and NIHSS score(P<0.05).The risk prediction model of secondary HT after intravenous thrombolysis in patients with acute cerebral infarction showed that the score of atrial fibrillation was 63

关 键 词：急性脑梗死 静脉溶栓 出血转化 影响因素 预测模型 受试者操作特征曲线 

分 类 号：R743.3[医药卫生—神经病学与精神病学]