溶栓前血钾与急性缺血性卒中患者溶栓后出血转化及短期预后的关系研究

Relationship between Serum Potassium before Thrombolysis and Hemorrhage Transformation after Thrombolysis and Short-Term Prognosis in Patients with Acute Ischemic Stroke

目的探究溶栓前血钾与急性缺血性卒中(AIS)患者溶栓后出血转化(HT)及短期预后的关系。方法选取2020年1月至2022年6月在郑州市第七人民医院急诊卒中绿色通道接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的AIS患者243例。所有患者接受阿替普酶静脉溶栓治疗,将发生HT的患者作为HT组(n=38),其余患者作为非HT组(n=205)。比较两组一般资料、溶栓前实验室检查指标、预后指标。采用多因素Logistic回归分析探讨AIS患者溶栓后发生HT的影响因素。绘制ROC曲线以评估相关指标对AIS患者溶栓后发生HT的预测价值。采用Spearman秩相关分析探讨血钾与AIS患者美国国立卫生研究院卒中量表(NIHSS)评分差值、治疗14 d后改良Rankin量表(mRS)评分的相关性。结果HT组有心房颤动史者占比、溶栓前NIHSS评分、溶栓前纤维蛋白原、mRS评分高于非HT组,溶栓前血钾、血钙及NIHSS评分差值低于非HT组(P<0.05)。多因素Logistic回归分析结果显示,溶栓前NIHSS评分升高是AIS患者溶栓后发生HT的独立危险因素,溶栓前血钾升高是AIS患者溶栓后发生HT的独立保护因素(P<0.05)。ROC曲线分析结果显示,溶栓前NIHSS评分、血钾预测AIS患者溶栓后发生HT的AUC分别为0.718〔95%CI(0.624,0.811)〕、0.764〔95%CI(0.702,0.826)〕,最佳截断值分别为17.5分、3.8 mmol/L,灵敏度分别为78.0%、62.0%,特异度分别为57.9%、94.7%。AIS患者溶栓前血钾与NHISS评分差值呈正相关(r_(s)=0.188,P=0.003),与治疗14 d后mRS评分呈负相关(r_(s)=-0.175,P=0.006)。结论溶栓前血钾升高是AIS患者溶栓后发生HT的独立保护因素,溶栓前血钾对AIS患者溶栓后发生HT有一定预测价值,且溶栓前血钾<3.8 mmol/L与AIS患者溶栓后短期预后不良有关。

Objective To explore the relationship between serum potassium before thrombolysis and hemorrhage transformation(HT)after thrombolysis and short-term prognosis in patients with acute ischemic stroke(AIS).Methods A total of 243 AIS patients who received intravenous thrombolysis therapy with recombinant tissue plasminogen activator(rt-PA)in the Green Channel of Emergency Stroke in the 7th People's Hospital of Zhengzhou from January 2020 to June 2022 were selected.All patients received intravenous thrombolytic therapy with alteplase.Patients with HT were included in the HT group(n=38)and the rest were included in the non-HT group(n=205).General data,laboratory indicators and prognostic indexes were compared between the two groups.Multivariate Logistic regression analysis was used to investigate the influencing factors of HT after thrombolysis in AIS patients.ROC curve was drawn to evaluate the predictive value of relevant indicators for HT after thrombolysis in AIS patients.Spearman rank correlation analysis was used to investigate the correlation between blood potassium and National Institutes of Health Stroke Scale(NIHSS)score difference and modified Rankin Scale(mRS)score after 14 d of thrombolysis.Results Proportian of patients with history of atrial fibrillation,pre-thrombolysis NIHSS score,pre-thrombolysis fibrinogen and mRS score in HT group were higher than those in non-HT group,pre-thrombolysis serum potassium,pre-thrombolysis calcium and NIHSS score difference were lower than those in non-HT group(P<0.05).Multivariate Logistic regression analysis showed that increased NIHSS score before thrombolysis was an independent risk factor for HT after thrombolysis in AIS patients,and increased blood potassium before thrombolysis was an independent protective factor for HT after thrombolysis in AIS patients(P<0.05).ROC curve analysis results showed that the AUC of pre-thrombolysis NIHSS score and pre-thrombolysis blood potassium in predicting HT after thrombolysis in AIS patients was 0.718[95%CI(0.624,0.811)]and 0.764[95%CI(0.702,0.826)],the optimal cut-off value was 17.5 points and 3.8 mmol/L,the sensitivity was 78.0%and 62.0%,and the specificity was 57.9%and 94.7%,respectively.Serum potassium before thrombolysis was positively correlated with NHISS score difference(r_(s)=0.188,P=0.003),and negatively correlated with mRS score 14 days after treatment(r_(s)=-0.175,P=0.006).Conclusion Increased serum potassium before thrombolysis is an independent protective factor for HT after thrombolysis in AIS patients.Serum potassium before thrombolysis has a certain predictive value for HT after thrombolysis in AIS patients,and pre-thrombolysis serum potassium<3.8 mmol/L is associated with poor short-prognosis after thrombolysis in AIS patients.