改良溶栓后出血评分量表在急性脑梗死溶栓后出血转化中的预测价值

Predictive value of modified hemorrhage after thrombolysis score scale in hemorrhagic transformation of acute cerebral infarction after thrombolysis

目的评价改良溶栓后出血评分量表(MHAT)评分的应用价值。方法前瞻性选择303例急性脑梗死溶栓治疗患者作为研究对象,记录患者性别、年龄、发病到就诊时间、入院时血压、血糖、美国国立卫生研究院卒中量表(NIHSS)评分、根据5种预测模型设计MHAT评分、心房颤动史(或现有心房颤动)、服用阿司匹林史、糖尿病史、高血压史、高脂血症史、冠心病史、入院后血小板计数、血纤维蛋白原浓度、6个月后再发脑梗死事件。结果303例急性脑梗死溶栓患者发生出血转化率11.88%;发生出血转化患者的年龄、发病到就诊时间、收缩压、舒张压、血糖、入急诊时NIHSS评分、MHAT评分和心房颤动、服用阿司匹林史比例均高于未发生出血转化患者(t分别=5.08、4.85、34.86、29.22、22.25、5.39、13.97,χ^(2)分别=3.93、4.73,P均<0.05),发生出血转化患者溶栓后6个月再发脑梗死率明显高于未发生出血转化患者(χ^(2)=4.46,P<0.05)。急性脑梗死溶栓后发生出血转化的MHAT均值为3.86分,95%CI 3.21~4.51;未发生出血转化的MHAT均值为2分,95%CI 1.82~2.18。结论脑梗死出血转化危险因素有年龄、发病到就诊时间、心房颤动、服用阿司匹林史、收缩压、舒张压、血糖、入急诊时NIHSS评分、MHAT评分;MHAT评分量表简单全面,能够很好地评估患者脑梗死溶栓后的出血转化风险,筛选高、低风险病例,对MHAT评分≥4分要高度警惕出现出血转化,更多选择MHAT评分≤2分者,以达到降低溶栓风险的目的。

Objective To evaluate the application value of the modified hemorrhage after thrombolysis(MHAT)score scale.Methods A total of 303 patients with acute cerebral infarction treated with thrombolytic therapy were prospectively studied.The gender,age,time from onset to admission,blood pressure,blood glucose,national institute of health stroke scale(NIHSS)score,MHAT score at admission designed according to five prediction models,history of atrial fibrillation(or existing atrial fibrillation),history of aspirin used,history of diabetes,history of hypertension,history of hyperlipid-emia,history of coronary heart disease,platelet counts,fibrinogen levels and recurrence of cerebral infarction 6 months after admission of the patients were recorded.Results The rate of hemorrhagic transformation was 11.88%in 303 acute cerebral infarction patients after thrombolysis.The age,time from onset to admission,systolic blood pressure,diastolic blood pressure,blood glucose,NIHSS score and MHAT score of patients with hemorrhagic transformation,and the rate of atrial fibrillation,history of taking aspirin were significantly higher than those of patients without hemorrhagic transforma-tion(t=5.08,4.85,34.86,29.22,22.25,5.39,13.97,χ^(2)=3.93,4.73,P<0.05).The recurrence rate of stroke in patients with hemorrhagic transformation 6 months after thrombolysis was significantly higher than that in patients without hemorrhagic transformation(χ^(2)=4.46,P<0.05).The mean value of MHAT for patients with hemorrhagic transformation after acute c-erebral infarction was 3.86,95%CI 3.21-4.51,and the mean value of MHAT for patients without hem-orrhagic transformation was 2,95%CI 1.82-2.18.Conclusion The risk factors of hemorrhagic trans-formation of cerebral infarction hemorrhage were age,time from onset to admisson,atrial fibrillation,history of aspirin taking,systolic and diastolic blood pressure, blood glucose,NIHSS score and MHAT score.The MHAT score is simple and comprehensive,it can well evaluate the risk of hemorrhage transformation after cerebral infarction thrombolysis,screen high and low risk cases. We should be high alert on hemorrhage transformation if the MHAT score is ≥4,and choose cases of MHAT≤2,in order to reduce the risk of thrombolysis.