不同量表对短暂性脑缺血发作/缺血性脑卒中患者抗血小板治疗后出血风险的预测价值

Predictive value of different scales for hemorrhage risk in patients with transient ischemic attack/ischemic stroke after anti-platelet therapy

目的比较S 2TOP-BLEED、REACH及颅内-B 2LEED 3S量表对短暂性脑缺血发作(TIA)/缺血性脑卒中患者抗血小板治疗后出血风险的预测价值。方法纳入48例TIA或缺血性脑卒中患者,均接受常规治疗、溶栓治疗及抗血小板治疗。根据抗血小板治疗12个月后是否发生大出血,将患者分为出血组19例和非出血组29例。比较出院时两组间S 2TOP-BLEED、REACH及颅内-B 2LEED 3S量表的评分。采用受试者工作特征曲线评价出院时3种量表对TIA/缺血性脑卒中患者抗血小板治疗后出血风险的预测效能。结果出血组S 2TOP-BLEED和REACH评分均高于非出血组(均P<0.05),但两组颅内-B 2LEED 3S评分差异无统计学意义(P>0.05)。S 2TOP-BLEED、REACH、颅内-B 2LEED 3S量表预测TIA/缺血性脑卒中患者抗血小板治疗后出血风险的最佳截点分别为14分、11分、7分,其中S 2TOP-BLEED量表的曲线下面积达0.906,均大于REACH和颅内-B 2LEED 3S量表(均P<0.05),且准确率、灵敏度、阳性预测值及阴性预测值均最高。结论与REACH和颅内-B 2LEED 3S量表相比,S 2TOP-BLEED量表评分在预测TIA/缺血性脑卒中患者抗血小板治疗后出血风险中有较高应用价值。

Objective To compare the predictive value of S 2TOP-BLEED,REACH and intracranial-B 2LEED 3S scales for hemorrhage risk in patients with transient ischemic attack(TIA)/ischemic stroke after anti-platelet therapy.Methods Forty-eight patients with TIA/ischemic stroke were enrolled,and all received routine therapy,thrombolysis therapy and anti-platelet therapy.According to the presence of massive hemorrhage 12 months after anti-platelet therapy,the patients were allocated to hemorrhage group(n=19)or non-hemorrhage group(n=29).The scores of S 2TOP-BLEED,REACH and intracranial-B 2LEED 3S scales at discharge were compared between the two groups.Receiver operating characteristic curve was used to assess the predictive efficiency of the three scales at discharge for hemorrhage risk in patients with TIA/ischemic stroke after anti-platelet therapy.Results The hemorrhage group exhibited higher scores of S 2TOP-BLEED and REACH scales as compared with the non-hemorrhage group(all P<0.05),but no significant difference in the score of intracranial-B 2LEED 3S scale was found between the two group(P>0.05).For predicting hemorrhage risk in patients with TIA/ischemic stroke after anti-platelet therapy,the optimal cut-offs of S 2TOP-BLEED,REACH and intracranial-B 2LEED 3S scales were 14 points,11 points and 7 points,respectively;S 2TOP-BLEED scale had larger area under the curve(reached 0.906)as compared with REACH or intracranial-B 2LEED 3S scale(all P<0.05),and obtained the highest accuracy rate,sensitivity,positive and negative predictive values.Conclusion Compared with REACH or intracranial-B 2LEED 3S scale,the score of S 2TOP-BLEED scale is of higher utility in predicting hemorrhage risk in patients with TIA/ischemic stroke after anti-platelet therapy.