五种风险量表对急性脑梗死患者静脉溶栓后症状性脑出血及不良转归预测的比较

Role of 5 risk scales in predicting symptomatic intracerebral hemorrhage and poor outcome in AIS patients after intravenous thrombolytic therapy

目的比较5种风险量表对急性脑梗死(AIS)患者静脉溶栓后症状性脑出血(sICH)与不良转归的预测价值。方法选择发病4.5h内接受重组组织型纤溶酶原激活剂静脉溶栓的AIS患者202例,用多中心脑卒中调查评分;年龄和美国国立卫生研究院卒中量表(NIHSS)的脑卒中预测评分;基线血糖、头颅CT早期脑梗死征、高密度血管征、年龄和NIHSS组合评分;血管事件健康风险汇总评分(THRIVE);入院血糖、种族、年龄、性别、入院收缩压、脑卒中严重程度组合评分等分别预测静脉溶栓后sICH与不良转归。用ROC曲线下面积(AUC)衡量量表预测能力。根据最大Youden指数的最佳量表截点值,将患者分为低危组(THRIVE≤3分)99例和高危组(THRIVE≥4分)103例,探讨分组与90d不良预后的关系。结果 5种风险量表预测sICH的AUC<0.8;THRIVE预测静脉溶栓后90d内死亡和不良预后的AUC最高(AUC=0.833,95%CI:0.768~0.893;AUC=0.813,95%CI:0.754~0.872)。THRIVE评分高危组较低危组90d不良预后更高(OR=11.498,95%CI:5.470~24.167,P<0.01)。结论5种风险量表对AIS静脉溶栓后sICH预测能力一般,THRIVE评分对90d不良转归预测能力较好。

Objective To study the role of 5risk scales in predicting sICH and poor outcome in AIS patients after intravenous thrombolytic therapy.Methods Two hundred and two AIS patients admitted to our hospital for intravenous thrombolytic therapy with rt-PA were included in this study.Their symptomatic cerebral hemorrhage and poor outcome were scored according to the MSS,NIHSS,SPAN-100,SEDAN,THRIVE,and GRASPS.The role of 5risk scales in predicting sICH and poor outcome in AIS patients after intravenous thrombolytic therapy was assayed according to the area under ROC（AUC）.The patients were divided into low risk group（n=99）with their THRIVE score≤3and high risk group（n=103）with their THRIVE score ≥4.Results The AUC was〈0.8for the 5risk scals in predicting sICH.The AUC was 0.833 and 0.813 respectively for the THRIVE in predicting the mortality and poor outcome in AIS patients after 90 days of intravenous thrombolytic therapy（95%CI：0.768-0.893,95%CI：0.754-0.872）.The THRIVE score was higher in predicting the poor outcome in high risk group than in low risk group after 90 days of intravenous thrombolytic therapy（OR=11.498,95%CI：5.470-24.167,P〈0.01）.Conclusion The role of 5risk scales is limited in predicting sICH in AIS patients after intravenous thrombolytic therapy.The role of THRIVE is better than that of the other 4scales in predicting the poor outcome in AIS patients after intravenous thrombolytic therapy.