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

目的比较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 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。

Objective To compare the predictive value of 5 scoring systems for hemorrhagic transformation risk after intravenous thrombolysis in patients with acute isehemic stroke （AIS） in different therapeutic windows. Methods 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 （multieenter 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 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 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.