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5种评分系统对不同时间窗急性脑梗死静脉溶栓后出血转化风险预测差异的比较研究
Prediction for hemorrhagic transformation risk after intravenous thrombolysis in acute ischemic stroke patients in different therapeutic windows: comparison of 5 scoring systems
- 第三军医大学学报 2017年39卷第17期 页码：1744-1749
- 作者机构：
400010 重庆，第三军医大学大坪医院野战外科研究所神经内科
- 作者简介：
[张猛，E-mail：172228621@qq.com ZHANG Meng, E-mail: 172228621@qq.com
- 基金信息：
DOI：10.16016/j.1000-5404.201702008
中图分类号： R181.2;R619.2;R743.3收稿：2017-02-04，
修回：2017-03-06，
纸质出版：2017-09-15
- 稿件说明：
移动端阅览
吴娅, 刘承春, 李玮, 等. 5种评分系统对不同时间窗急性脑梗死静脉溶栓后出血转化风险预测差异的比较研究[J]. 第三军医大学学报, 2017,39(17):1744-1749.
Ya WU, Chengchun LIU, Wei LI, et al. Prediction for hemorrhagic transformation risk after intravenous thrombolysis in acute ischemic stroke patients in different therapeutic windows: comparison of 5 scoring systems[J]. Journal of Third Military Medical University, 2017, 39(17): 1744-1749.
吴娅, 刘承春, 李玮, 等. 5种评分系统对不同时间窗急性脑梗死静脉溶栓后出血转化风险预测差异的比较研究[J]. 第三军医大学学报, 2017,39(17):1744-1749. DOI： 10.16016/j.1000-5404.201702008.
Ya WU, Chengchun LIU, Wei LI, et al. Prediction for hemorrhagic transformation risk after intravenous thrombolysis in acute ischemic stroke patients in different therapeutic windows: comparison of 5 scoring systems[J]. Journal of Third Military Medical University, 2017, 39(17): 1744-1749. DOI： 10.16016/j.1000-5404.201702008.
摘要
目的
2
比较5种评分系统对不同时间窗的急性脑梗死静脉溶栓后出血转化(hemorrhagic transformation，HT)风险的预测价值。
方法
2
对2014年1月至2016年12月对不同时间窗内仅接受重组组织型纤溶酶原激活物(recombinant tissue-type plasminogen activator，rt-PA)静脉溶栓的243例急性脑梗死患者进行单中心、回顾性研究。应用HAT评分、GRASPS评分、SEDAN评分、MSS评分及SITS评分量表进行测评，观察5种评分系统与不同时间窗内的急性脑梗死接受静脉溶栓后出现HT的关系；应用ROC曲线下面积大小比较5种评分系统在不同时间窗静脉溶栓后出HT的预测能力。
结果
2
针对不同时间窗，比较5种评分系统ROC曲线下面积，结果显示：≤3 h时GRASPS及HAT评分系统的ROC曲线下面积(分别为0.698、0.619) 高于其他评分系统；＞3~4.5 h时，SEDAN评分、HAT评分(ROC面积分别为0.744，0.719) 优于其他评分系统(
P
＜0.05)；＞4.5~6 h时，HAT评分系统(ROC曲线下面积为0.676) 优于其他评分系统。
结论
2
5种评分系统对所有时间窗静脉溶栓后HT的发生有较好的预测能力。在不同时间窗，特别是在4.5 h内，HAT评分系统对HT风险预测可能拥有相对较好的预测价值。
Abstract
Objective
2
To compare the predictive value of 5 scoring systems for hemorrhagic transformation risk after intravenous thrombolysis in patients with acute ischemic stroke (AIS) in different therapeutic windows.
Methods
2
A single-center and retrospective study was performed for 243 AIS patients who underwent intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) in different therapeutic windows in our department during January 2014 and December 2016. Five scoring systems
including HAT model (hemorrhage after thrombolysis)
MSS model (multicenter stoker survey)
GRASPS model (glucose at presentation
race
age
sex
systolic blood pressure at presentation
severity of stroke at presentation)
SEDAN model (baseline blood sugar
early infarct signs
hyperdense cerebral artery sign on admission CT
age
NIHSS on admission)
and SITS model (safe implementation of thrombolysis in stroke-monitoring study) were used to evaluate the risks for hemorrhagic transformation. The relationships between the 5 scoring systems and incidence rate of hemorrhagic transformation were analyzed among the patients in different therapeutic windows. The predictive values of the 5 scoring systems were compared using the areas (AUC) under the receiver operating characteristic (ROC) curve.
Results
2
When the AIS patients were treated by intravenous thrombolysis within 3 h
the AUC of GRASPS and HAT models were 0.698 and 0.619
respectively
higher than those of the other 3 systems. When the therapeutic window was between 3 to 4.5 h
HAT model and SEDAN model had highest AUC (0.719
0.744) than the other 3 systems (
P
<
0.05). When the windows were
>
4.5~6 h
the HAT model had the highest AUC (0.676).
Conclusion
2
The 5 scoring systems show better predictive value for hemorrhagic transformation after intravenous thrombolysis. For the therapeutic window within 4.5 h
HAT model presents best predictive value than the other 4 scoring systems.
关键词
Keywords
references
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