摘要
目的:分析急性缺血性脑卒中（AIS）患者给予静脉阿替普酶溶栓治疗后出血转化的相关危险因素。方法:本研究为回顾性研究，根据纳入和排除标准，共纳入2019年8月至2022年5月于新疆医科大学第一附属医院急救中心确诊为AIS并行静脉溶栓治疗的195例患者，根据静脉溶栓后是否发生出血转化分为出血组（26例）和未出血组（169例）。收集患者临床一般资料（包括性别、年龄、既往史等）及相关实验室检验（血常规、生化全项、凝血等）结果，采用单因素分析比较上述资料的组间差异，针对AIS静脉溶栓后出血转化的危险因素行二元Logistic回归分析及受试者操作特征（ROC）曲线分析。结果:单因素分析显示，出血组和未出血组组间美国国立卫生研究院卒中量表（NIHSS）评分[10（5，16）分 vs 4（2，7）分]、凝血酶原时间[11.90（11.00，12.90）s vs 11.30（10.90，12.10）s]、凝血酶原活动度[92.19%（76.67%，112.26%）vs 104.55%（88.88%，114.93%）]、国际标准化比率[1.03（0.96，1.12）vs 0.98（0.95，1.05）]、凝血酶时间[20.10（19.30，21.15）s vs 19.40（18.35，20.30）s]、肌酐[81.28（62.75，102.89）μmol/L vs 66.76（55.36，79.04）μmol/L]、估算的肾小球滤过率（eGFR）[72.97（57.73，103.19）% vs 95.23（82.86，107.71）%]、中性粒细胞计数[5.01（4.26，6.06）×109/L vs 4.34（3.33，5.49）×109/L]、糖化血红蛋白[6.61%（6.61%，6.66%）vs 6.3%（5.70%，6.61%）]、房颤病史（5/26 vs 12/169）比较，差异均具有统计学意义（Z=-4.133，P＜0.001；Z=-2.158，P=0.031；Z=-2.201，P=0.028；Z=-2.200，P=0.028；Z=-2.154，P=0.031；Z=-2.818，P=0.005；Z=-3.367，P＜0.001；Z=-1.971，P=0.049；Z=-2.513，P=0.012；χ2=4.166，P=0.041）。经多因素二元Logistic回归分析显示，NIHSS评分（OR=1.129，95%CI：1.037~1.230）、中性粒细胞计数（OR=1.247，95%CI：1.019~1.527）是AIS静脉溶栓后出血转化的独立危险因素（P＜0.05），eGFR（OR=0.961，95%CI：0.927~0.996）是AIS静脉溶栓后出血转化的独立保护因素（P＜0.05）；NIHSS评分、中性粒细胞计数、eGFR联合预测AIS静脉溶栓后出血转化的ROC曲线下面积为0.798（95%CI：0.703~0.893）。结论:NIHSS评分、中性粒细胞计数是AIS静脉溶栓后出血转化的独立危险因素，eGFR是AIS静脉溶栓后出血转化的独立保护因素，三者联合对AIS静脉溶栓后出血转化有较好的预测价值。
Abstract
Objective:To analyze the risk factors related to hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after intravenous alteplase thrombolytic therapy.Methods:This was a retrospective study. According to the inclusion and exclusion criteria, a total of 195 patients diagnosed with AIS and treated with intravenous thrombolysis were enrolled in the Emergency Center of the First Affiliated Hospital of Xinjiang Medical University from August 2019 to May 2022. According to whether bleeding occurred after intravenous thrombolysis, it was divided into the bleeding group (26 cases) and the non-bleeding group (169 cases). General clinical data (including gender, age, past history, etc.) and relevant laboratory test results (blood routine, biochemical complete items, coagulation routine, etc.) were collected. Univariate analysis was used to compare the group differences in the above data. Binary Logistic regression analysis and ROC curve analysis were performed for the risk factors of HT after AIS intravenous thrombolysis.Results:There were statistically significant between the bleeding group and the non-bleeding group of National Institutes of Health Stroke Scale (NIHSS) score[10(5, 16) vs 4(2, 7); Z=-4.133, P＜0.001], baseline prothrombin time [11.90(11.00, 12.90) s vs 11.30(10.90, 12.10) s; Z=-2.158, P=0.031], prothrombin activity [92.19%(76.67%, 112.26%) vs 104.55%(88.88%, 114.93%); Z=-2.201, P=0.028], international standardized ratio [1.03(0.96, 1.12) vs 0.98(0.95, 1.05); Z=-2.200, P=0.028], thrombin time [20.10(19.30, 21.15) s vs 19.40(18.35, 20.30) s; Z=-2.154, P=0.031], creatinine [81.28(62.75, 102.89) μmol/L vs 66.76(55.36, 79.04) μmol/L; Z=-2.818, P=0.005], estimated glomerular filtration rate (eGFR)[72.97(57.73, 103.19)% vs 95.23(82.86, 107.71)%; Z=-3.367, P＜0.001], neutrophil count (NEUT) [5.01(4.26, 6.06)×109/L vs 4.34(3.33, 5.49)×109/L; Z=-1.971, P=0.049], glycosylated hemoglobin [6.61%(6.61%, 6.66%) vs 6.3%(5.70%, 6.61%); Z=-2.513, P=0.012], and history of atrial fibrillation (5/26 vs 12/169; χ2=4.166, P=0.041). Multivariate logistic regression showed that NIHSS score (OR=1.129, 95%CI: 1.037-1.230) and NEUT (OR=1.247, 95%CI: 1.019-1.527) were independent risk factors for HT after intravenous thrombolysis in AIS (P＜0.05), eGFR (OR=0.961, 95%CI: 0.927-0.996), were independent protective factors for HT after AIS intravenous thrombolysis (P＜0.05); The area under ROC curve of NIHSS score, NEUT and eGFR combined to predict HT after intravenous thrombolysis was 0.798 (95%CI: 0.703-0.893).Conclusion:NIHSS score and NEUT were independent risk factors for HT after intravenous thrombolysis in AIS, and eGFR was an independent protective factor for HT after intravenous thrombolysis in AIS. The combination of NIHSS score, NEUT, and eGFR had better predictive value for HT after intravenous thrombolysis in AIS.
万方数据