应用列线图模型预测急性非心源性卒中大血管病变患者溶栓治疗后出血转化情况  

Using linear graph model to predict hemorrhage transformation after thrombolytic therapy in patients with acute non-cardiogenic stroke macrovascular disease

作　　者：张雪玲 王一峰 孙威 林晓光 刘芹芹 陈念东 杜娟 杜合宾 王黎明 ZHANG Xueling;WANG Yifeng;SUN Wei;LIN Xiaoguang;LIU Qinqin;CHEN Niandong;DU Juan;DU Hebin;WANG Liming(Suqian Hospital Affiliated to Xuzhou Medical University,Suqian 223800,China)

机构地区：[1]徐州医科大学附属宿迁医院,江苏宿迁223800

出　　处：《中国实用神经疾病杂志》2023年第7期824-829,共6页Chinese Journal of Practical Nervous Diseases

基　　金：国家自然科学基金(编号:81571212);宿迁市科技计划(重点研发计划社会发展)项目(编号:S202203);江苏省高校重点实验室开放课题资助项目(编号:XZSYSKF2022023)。

摘　　要：目的研究列线图模型预测急性非心源性卒中大血管病变患者溶栓治疗后出血转化情况的价值。方法开展前瞻性研究,以2019-01—2021-12徐州医科大学附属宿迁医院治疗的120例急性非心源性卒中大血管病变患者为研究对象,所有患者均采取静脉溶栓治疗,分析急性非心源性卒中大血管病变患者溶栓治疗后出血转化的危险因素,并构建相关的预测模型。结果出血转化组与非出血转化组患者的高血压、冠心病、大脑中动脉高密度征(HMCAS)、前循环病变、急性脑卒中早期CT评分(ASPECTS)、美国国立卫生研究院卒中量表(NIHSS)评分差异有统计学意义(P<0.05)。通过多因素分析,高血压、冠心病、HMCAS、前循环病变及较低的ASPECTS、较高的NIHSS评分均是造成脑卒中患者出血转化的独立危险因素。通过列线图模型预测分析,伴高血压、冠心病、HMCAS、前循环病变及ASPECTS评分<4.11分、NIHSS评分>12.33分时可认为脑卒中患者存在溶栓治疗后的出血转化风险。通过ROC曲线分析,上述模型对脑卒中患者的出血转化风险具有较高的预测价值。结论高血压、冠心病、HMCAS、前循环病变及较低的ASPECTS评分、较高的NIHSS评分均是造成急性非心源性卒中大血管病变患者溶栓治疗后出血转化的危险因素。Objective To study the value of using linear graph model to predict hemorrhagic transforma⁃tion in patients with acute non-cardiogenic stroke macrovascular disease after thrombolytic therapy.Methods This is a prospective study.Totally 120 patients with acute non-cardiogenic stroke macrovascular disease diag⁃nosed and treated in Suqian Hospital Affiliated to Xuzhou Medical University from January 2019 to December 2021 were selected as research subjects.All patients were treated by intravenous thrombolysis.The risk factors of hemorrhagic transformation after thrombolytic therapy in patients with acute non-cardiogenic stroke and macrovas⁃cular disease were analyzed,and a related predictive model was constructed.Results There were statistically sig⁃nificant differences in hypertension,coronary heart disease,HMCAS,anterior circulation lesions,ASPECTS and NIHSS between hemorrhagic transformation group and non-hemorrhagic transformation group(P<0.05).Through multivariate analysis,hypertension,coronary heart disease,HMCAS and anterior circulation lesions,lower ASPECTS score and higher NIHSS score were independent risk factors for hemorrhagic transformation in acute stroke patients.According to prediction analysis of linear graph model,hypertension,coronary heart disease,HMCAS and anterior circulation lesions,ASPECTS scores lower of 4.11 and NIHSS scores higher of 12.33 points could be con⁃sidered as the risk of hemorrhage transformation after thrombolytic therapy.Through ROC curve analysis,the above model had high predictive value for the risk of hemorrhagic transformation in acute stroke patients.Conclu⁃sion Hypertension,coronary heart disease,HMCAS,anterior circulation lesions,lower ASPECTS score and higher NIHSS score are all risk factors for hemorrhagic transformation in patients with acute non-cardiogenic stroke mac⁃rovascular lesions after thrombolytic therapy.

关 键 词：急性非心源性卒中 脑卒中 大血管病变 出血转化 列线图模型 预测价值 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]