缺血性脑卒中患者出血转化的危险因素分析及预测模型研究

Risk factors of hemorrhage transformation after ischemic stroke and its prediction model

目的 通过对缺血性脑卒中患者发生出血转化（HT）的危险因素进行研究,建立同样适用于非溶栓患者的预测模型.方法 选取2015年1月至2016年9月青岛大学附属医院神经内科收治的327例缺血性脑卒中患者,对患者的卒中病因、临床表现、一般资料等进行回顾性分析.采用logistic回归分析法筛选出HT的危险因素,建立新的预测模型,绘制ROC曲线获得评分界值,大于评分界值的为HT高危组.结果 心房颤动病史（OR=4.94,95%CI：1.879-12.988,P〈0.05）、收缩压≥160mmHg（OR=2.762,95%CI：1.175-6.494,P〈0.05,1mmHg=0.133kPa）、大面积脑梗死（OR=3.796,95%CI：1.495-9.635,P〈0.05）、NIHSS评分≥10分（OR=5.665,95%CI：2.289-14.021,P〈0.05）、溶栓（OR=3.086,95%CI：4.981-96.257,P〈0.05）为HT的独立危险因素.根据logistic回归分析结果建立新的预测模型,Logit P=-3.588＋1.579×X1＋1.016×X2＋1.334×X3＋1.734×X4＋3.086×X5.ROC曲线下的面积0.912（95%CI：0.873-0.950,P〈0.001）,预测模型诊断价值较高.取界值为-2,此时灵敏度88.33%,特异度为82.02%.结论 心房颤动病史、收缩压≥160mmHg、大面积脑梗死、NIHSS评分≥10分、溶栓治疗为HT的独立危险因素;当界值〉-2时,发生HT的风险显著增高.

Objective To establish a prediction model by analyzing the related risk factors of hemorrhage transformation （HT） after ischemic stroke.Methods A retrospective study was performed on 327 cases of patients with ischemic stroke who were admitted from January 2015 to September 2016.The pathogenesis,clinical manifestation and general data of patients were retrospectively analyzed.The risk factors of HT were selected by logistic regression analysis and other methods,a new prediction model was established,and the evaluation boundary value of the ROC curve was obtained,which was greater than the evaluation boundary value was in HT high risk group.Results Atrial fibrillation （OR=4.940,95%CI：1.879-12.988,P〈0.05）,systolic blood pressure higher than 160 mmHg （OR=2.762,95%CI：1.175-6.494,P〈0.05,1 mmHg=0.133 kPa）,massive cerebral infarction （OR=3.796,95%CI：1.495-9.635,P〈0.05）,NIHSS score more than 10 points （OR=5.665,95%CI：2.289-14.021,P〈0.05）,thrombolytic treatment （OR=3.086,95%CI：4.981-96.257,P〈0.05） were independent risk factors for HT.Prediction model：Logit P=-3.588＋1.579×X1＋1.016×X2＋1.334×X3＋1.734×X4＋3.086×X5.The AUC was 0.912 （95%CI：0.873-0.950,P〈0.001）.When the boundary value was-2,the sensitivity was 88.33%,specificity is 82.02%.Conclusion Atrial fibrillation history,systolic blood pressure which is higher than 160 mmHg,massive cerebral infarction,NIHSS score is more than 10 point,and thrombolytic treatment are independent risk factors for HT.The patient will have a higher risk of HT,when the boundary value is greater than-2.