用SITS SICH风险评分预测脑梗死rt-PA静脉溶栓后症状性颅内出血风险的临床研究

Clinical Study on The SITS SICH Risk Score to Predicting the Risk of Symptomatic Intracerebral Hemorrhage in Cerebral Infarction Treated with Recombinant Tissue Plasminogen Activator(rt-PA)

目的:探索SITS SICH风险评分预测中国急性脑梗死患者rt-PA静脉溶栓(时间窗为4.5 h,rt-PA剂量0.9 mg/kg体重)治疗后症状性颅内出血(SICH)风险的效果,为使用SITS SICH风险评分指导溶栓治疗积累临床经验。方法:对86名进行rt-PA静脉溶栓(剂量0.9 mg/kg体重)的急性脑梗死患者,进行SITS SICH风险评分,并记录总分及风险水平分层结果,按总分0、1、2、3、4、5、6、7、8、≥9分,分为10组,再按风险水平低危、平均、中危、高危分为4组,记录各组患者溶栓后有颅内出血(包括SICH)的比例,各组间进行比较。结果:SITS SICH风险评分0-5分、6分、7分、8分、≥9分各组SICH的比例分别为0.0%、8.3%、10.0%、25%和50.0%,卡方检验得x2=64.38,P<0.001(线性趋势检验),提示随着SITS SICH风险评分值的增加SICH的比例也在增加,存在统计学上的差异。SITS SICH风险评分风险水平低危及平均组的SICH比率为0%,中危、高危组的SICH比率分别11.5%,50%,卡方检验得x2=59.52,P<0.001(线性趋势检验),提示SITS SICH风险水平越高,SICH的比例也越高,存在统计学上的差异。另外,将SITS SICH风险评分风险水平分层和出血类型做spearman等级相关分析,得到spearman相关系数0.422,P<0.001;说明SITS SICH风险评分风险水平分层和SICH呈正相关。结论:对于经标准的rt-PA静脉溶栓方案(时间窗为4.5h,rt-PA剂量0.9 mg/kg体重)治疗中国急性脑梗死患者,SITS SICH风险评分分值的增加与SICH风险的增加呈正相关,SITS SICH风险评分是一个能够预测rt-PA静脉溶栓后SICH风险的简单易行的实用的临床工具。

Objective： To explore the effect of the SITS SICH Risk Score in predicting the risk of Symptomatic Intracerebral Hem- orrhage（SICH） in ischemic stroke treated with recombinant tissue Plasminogen Activator（rt-PA） （0.9 mg/kg） in 4.5 hours time window. Methods： 86 patients with acute cerebral infarction treated by intravenous rt-PA （0.9 mg/kg） were assigned to 10 groups by the SITS SICH Risk Score （0,1,2,3,4,5,6,7,8and-〉 9）, and were assigned again to 4 groups by SITS SICH Risk level（low, average, moderate, high）. The proportion of SICH recorded in detail, and compared the data between the groups. Results： The rate of SICH in groups of total points 0-5, 6, 7, 8and-〉 9 were 0.0%, 8.3%, 10.0%, 25% and 50.0%, （x2=64.38, P〈0.001, linear trend test）, respectively. These results implied the percentage of patients, who developed SICH after rt-PA increased with higher SITS SICH Risk scores. The rate of SICH in groups of risk level low and average were0 %, risk level moderate and high werel 1.5 %, 50 %, （x2=-59.52, P〈0.001, Linear trend test）, re- spectively. These results implied the risk of the patients who developed SICH after rt-PA increased with higher SITS SICH risk level. The SITS SICH risk level and hemorrhage type spearman rank correlation were analyzed, the spearman correlation coefficient was 0.422, P〈0.001, these results implied the SITS SICH risk level and SICH were positively correlated. Conclusion： The SITS SICH Risk Score is a practical, simple and easy-to perform scale, and it could predict the risk of SICH in cerebral infarction treated with rt-PA （0.9 mg / kg）in 4.5 hours time window.