动态动脉僵硬指数与老年急性缺血性脑卒中患者静脉溶栓后出血转化的相关性分析

Relationship between AASI and hemorrhagic transformation in elderly AIS patients after intravenous thrombolysis

目的探讨动态动脉僵硬指数(ambulatory arterial stiffness index,AASI)与老年急性缺血性脑卒中(acute ischemic stroke,AIS)患者静脉溶栓后出血转化的相关性。方法选择2016年1月~2019年12月于葫芦岛市中心医院接受静脉溶栓治疗的老年(年龄>65岁)AIS患者224例,根据欧洲急性卒中协作组分类标准分为出血转化组48例和非出血转化组176例。比较2组人口学资料、脑血管病危险因素、实验室检查等指标。采用logistic回归分析和ROC曲线分析。结果本研究出血转化率为21.4%。与非出血转化组比较,出血转化组年龄、高血压、心房颤动、心源性栓塞型比例、入院时NIHSS评分、空腹血糖及AASI明显升高,小动脉闭塞型比例明显降低,差异有统计学意义(P<0.05,P<0.01)。多因素logistic分析模型显示,年龄、心房颤动、入院时NIHSS评分及AASI是老年AIS患者溶栓后出血转化的独立危险因素(OR=1.095,95%CI:1.031~1.163,P=0.003;OR=2.931,95%CI:1.292~6.653,P=0.010;OR=1.085,95%CI:1.018~1.156,P=0.012;OR=1.723,95%CI:1.166~2.544,P=0.006)。AASI预测出血转化发生的潜在最佳临界值为0.619,ROC曲线下面积为0.631(95%CI:0.564~0.694,P=0.004),敏感性为77.08%,特异性为47.16%。结论AASI是老年AIS患者接受静脉溶栓治疗后发生出血转化的一个独立危险因素。

Objective To study the relationship between ambulatory arterial stiffness index(AASI)and hemorrhagic transformation in elderly AIS patients after intravenous thrombolysis.Methods Two hundred and twenty-four elderly AIS patients with their age>65 years who underwent intravenous thrombolysis in our hospital from January 2016 to December 2019 were divided into hemorrhagic transformation group(n=48)and hemorrhagic transformation-free group(n=176)according to the standard of European cooperative stroke study.The demographic data,risk factors for cerebrovascular disease,and laboratory testing parameters were compared between the two groups,and analyzed by multivariate logistic regression analysis and ROC curve analysis respeetively.Results The rate of hemorrhagic transformation was 21.4%in elderly AIS patients included in this study.The age was significantly older,the incidence of hypertension,AF,cardiogenic embolism,and the NIHSS score,fasting blood glucose and AASI on admission were significantly higher while the incidence of small artery occlusion was significantly lower in hemorrhagic transformation group than in hemorrhagic transformation-free group(P<0.01,P<0.01).Multivariate logistic regression analysis showed that age,AF,NIHSS score and AASI on admission were the risk factors for hemorrhagic transformation in elderly AIS patients after intravenous thrombolysis(OR=1.095,95%CI:1.031-1.163,P=0.003;OR=2.931,95%CI:1.292-6.653,P=0.010;OR=1.085,95%CI:1.018-1.156,P=0.012;OR=1.723,95%CI:1.166-2.544,P=0.006).The optimal cut-off value for AASI in predicting hemorrhagic transformation in elderly AIS patients after intravenous thrombolysis was 0.619.The AUC for AASI in predicting hemorrhagic transformation in elderly AIS patients after intravenous thrombolysis was 0.631 with a sensitivity of 77.08%and a specificity of 47.16%.Conclusion AASI is an independent risk factor for hemorrhagic transformation in elderly AIS patients after intravenous thrombolysis.