摘要
目的 探讨急性大脑中动脉闭塞患者机械取栓再通后发生出血转化(HT)的危险因素。方法 根据术后HT情况,将104例急性大脑中动脉闭塞机械取栓再通患者分为HT组29例及非HT组75例。收集患者的一般临床资料,将单因素分析时有统计学意义的因素进行二分类Logistic回归分析,并绘制ROC曲线。结果 与非HT组比较,HT组糖尿病比率、急诊血糖水平、术前NIHSS评分显著升高,饮酒史比率显著降低,取栓次数显著增加(均P<0.05)。Logistic回归分析显示,急诊血糖、术前NIHSS评分、取栓次数是急性大脑中动脉闭塞机械取栓术后HT的独立危险因素(OR=1.264,95%CI:1.019~1.569,P=0.033;OR=1.201,95%CI:1.066~1.355,P=0.003;OR=2.698,95%CI:1.232~5.910,P=0.013)。急诊血糖水平、术前NIHSS评分、取栓次数联合预测模型的ROC曲线下面积(AUC)为0.794(95%CI:0.692~0.896,P<0.001),Youden指数为0.514,敏感性为0.621,特异度为0.893。联合预测模型的预测价值高于急诊血糖(AUC=0.622,P=0.055)、术前NIHSS评分(AUC=0.689,P=0.003)、术中取栓次数(AUC=0.601,P=0.112)单独的预测价值。结论 急诊血糖、术前NIHSS评分、取栓次数是急性大脑中动脉闭塞机械取栓再通后HT的独立危险因素,对于取栓再通后HT具有预测价值。
Objective To investigate the risk factors for hemorrhagic transformation(HT)after recanalization of mechanical thrombectomy in patients with acute middle cerebral artery occlusion.Methods According to postoperative HT status,104 patients with acute middle cerebral artery occlusion who underwent mechanical thrombectomy and recanalization were divided into HT group(29 cases)and non-HT group(75 cases).General clinical data were collected,and factors with statistical significance in univariate analysis were subjected to binary Logistic regression analysis,with ROC curves drawn.Result Compared with those in non-HT group,the ratio of diabete,emergency blood glucose level and preoperative NIHSS score in HT group were significantly increased,the ratio of drinking history was significantly decreased,and the number of thrombectomies was significantly increased(all P<0.05).Logistic regression analysis showed that emergency blood glucose,preoperative NIHSS score and number of thrombectomies were independent risk factors for HT after mechanical thrombectomy for acute middle cerebral artery0cclusion(OR=1.264,95%CI:1.019-1.569,P=0.033;0R=1.201,95%CI:1.066-1.355,P=0.O03;OR=2.698,95%CI:1.232-5.910,P=0.013).The area under curve(AUC)of the ROC of the combined prediction model for emergency blood glucose level,preoperative NIHSS score and number of thrombectomies was 0.794(95%CI:0.692-0.896,P<0.001),Youden index was 0.514,the sensitivity was 0.621,and the specificity was 0.893.The predictive value of the combined prediction model was higher than those of emergency blood glucose(AUC=0.622,P=0.055),preoperative NIHSSscore(AUC=0.689,P=0.003)and number of thrombectomies(AUC=0.601,P=0.112).Conclusion Emergency blood glucose level,preoperative NIHSS score,and the number of thrombectomies are independent risk factors for HT after mechanical thrombectomy in acute middle cerebral artery occlusion,and have predictive value for HT after thrombectomy.
作者
褚忠海
陈季南
杨倩
陈靖
CHU Zhonghai;CHEN Jinan;YANG Qian(Department of Neurology,Nanjing Jiangning Hospital,Nanjing 211100,China)
出处
《临床神经病学杂志》
2026年第1期11-15,共5页
Journal of Clinical Neurology
基金
南京医科大学康达学院2023年度科研发展基金(KD2023KYJJ257)。
关键词
急性大脑中动脉闭塞
急性缺血性脑卒中
出血转化
机械取栓
acute middle cerebral artery occlusion
acute ischemic stroke
hemorrhagic transformation
mechanical thrombectomy
