摘要
目的探讨急性缺血性脑卒中(Acute ischemic stroke,AIS)患者接受重组组织型纤溶酶原激活剂(Recombinant tissue plasminogen activator,rt-PA)溶栓治疗后出血转化(Hemorrhagic transformation,HT)的多因素预测,为临床风险评估和治疗决策提供参考依据。方法回顾性分析2021年8月至2024年11月在华北理工大学附属医院急诊科确诊AIS并接受rt-PA溶栓治疗的AIS患者临床资料。根据是否发生HT分为HT组和非HT组,比较两组患者的临床资料、实验室及影像学检查结果,采用单因素分析筛选潜在的危险因素,通过多因素Logistic回归分析确定独立危险因素,绘制受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析相关危险因素对HT发生的预测价值。结果175例溶栓患者中,37例(21.1%)发生HT。HT组和非HT组患者在年龄、入院收缩压、梗死面积比较差异有统计学意义(P<0.05);ROC曲线分析表明,年龄>79岁、入院收缩压>179 mmHg、脑梗死面积>3 cm+2及三者联合预测对AIS患者rt-PA溶栓后HT的曲线下面积(Area under curve,AUC)分别为0.695(95%CI:0.612~0.777)、0.714(95%CI:0.628~0.801)、0.621(95%CI:0.522~0.719)、0.803(95%CI:0.732~0.875),联合预测的价值更高(P<0.05)。结论年龄>79岁、入院收缩压>179 mmHg、梗死面积>3 cm+2预测是AIS患者rt-PA溶栓治疗后HT的危险因素,且对HT的发生有一定的预测价值,上述指标联合应用时的预测价值更高。
Objective To investigate the multifactorial predictors of hemorrhagic transformation(HT)following recombinant tissue plasminogen activator(rt-PA)thrombolytic therapy in patients with acute ischemic stroke(AIS),and to provide evidence for clinical risk assessment and therapeutic decision-making.Methods Clinical data from AIS patients treated with rt-PA thrombolysis at the hospital between August 2021 and November 2024 were retrospectively analyzed.The patients were categorized into HT and non-HT groups based on the occurrence of HT.Clinical parameters,laboratory findings and neuroimaging results were compared.Potential risk factors were identified via univariate analysis,and independent predictors were determined using multivariate Logistic regression analysis.The predictive value of related risk factors for the occurrence of HT was analyzed using the receiver operating characteristic curve(ROC).Results Among the 175 patients who received thrombolytic therapy,37(21.1%)developed HT.There were statistically significant differences in age,admission systolic blood pressure and infarction area between the HT group and the non-HT group(P<0.05).ROC curve analysis showed that the area under the curve(AUC)for HT after rt-PA thrombolysis in AIS patients with age>79 years,admission systolic blood pressure>179 mmHg,cerebral infarction area>3 cm+2,and the combined prediction of the three were 0.695(95%CI:0.612-0.777),0.714(95%CI:0.628-0.801),0.621(95%CI:0.522-0.719)and 0.803(95%CI:0.732-0.875)respectively.The combined prediction values were higher(P<0.05).Conclusion Age>79 years old,admission systolic blood pressure>179 mmHg and infarction area>3 cm+2 are predicted to be risk factors for HT in AIS patients after rt-PA thrombolytic therapy,and have certain predictive value for the occurrence of HT.The predictive value is higher when the above indicators are combined.
作者
齐丽艳
李弘
王树君
刘煜
张为佳
QI Liyan;LI Hong;WANG Shujun;LIU Yu;ZHANG Weijia(Department of Emergency,North China University of Science and Technology Affiliated Hospital,Tangshan Hebei 063000,China;Department of Neurological Intensive Care,North China University of Science and Technology Affiliated Hospital,Tangshan Hebei 063000,China)
出处
《新疆医科大学学报》
2025年第10期1414-1418,共5页
Journal of Xinjiang Medical University
基金
河北省科技计划项目(230149A105)。
关键词
缺血性卒中
组织型纤溶酶原激活剂
血栓溶解疗法
脑出血
危险因素
ischemic stroke
tissue plasminogen activator
thrombolytic therapy
intracranial hemorrhages
risk factors
