年龄 房颤 舒张压对急性缺血性脑卒中rt-PA静脉溶栓后出血转化的影响

Influence of age atrial fibrillation and diastolic pressure on hemorrhage transformation after intravenous thrombolysis with RT-PA in acute ischemic stroke

目的 探究年龄、房颤和舒张压对急性缺血性脑卒中重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后发生颅内出血转化的影响因素。方法 采用随机抽样的方法,选取2020年1月至2021年12月蚌埠市第三人民医院卒中中心收治的采用rt-PA静脉溶栓治疗的急性缺血性脑卒中患者92例,根据是否发生颅内出血分为出血组(n=20)和非出血组(n=72)。对两组患者的临床资料进行单因素分析,对存在统计学差异的变量(年龄、房颤和舒张压)进行二元logistic回归,构建临床预测方程,检测方程的区分度和校准度,利用受试者工作特征(ROC)曲线分析影响因素的预测效度,用分层回归分析差异变量舒张压在年龄和是否出血转化间的中介效应。结果 两组患者年龄、房颤和舒张压存在差异,二元logistic回归结果显示,年龄(OR=1.072,95%CI:1.007~1.142)、房颤(OR=12.980,95%CI:1.701~99.026)、舒张压(OR=1.076,95%CI:1.030~1.123)是rt-PA静脉溶栓后颅内出血的危险因素,ROC曲线分析显示,年龄曲线下面积(AUC=0.692,P=0.003,诊断界限值72.5岁)、舒张压(AUC=0.844,P<0.001,诊断界限值82.5 mmHg)和房颤(AUC=0.690,P=0.004)对出血转化有较好的预测效度,中介分析显示,舒张压、房颤在年龄和是否出血转化间起部分中介作用。结论 高舒张压、伴发房颤和老年是急性缺血性脑卒中rt-PA静脉溶栓后颅内出血发生的危险因素,rt-PA静脉溶栓前调整舒张压,针对房颤采取防治措施可能是减少老年人发生溶栓后出血转化的重要手段。

Objective To investigate the influencing factors of intracranial hemorrhage after intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA) in acute ischemic stroke and explore the influencing mechanism of age, atrial fibrillation and diastolic blood pressure. Methods From January 2020 to December 2021, 92 patients with acute ischemic stroke treated by intravenous thrombolytic therapy with rt-PA in the Stroke Center of The Third People’s Hospital of Bengbu were selected by random sampling. According to the occurrence of intracranial hemorrhage, they were divided into bleeding group(n=20) and non-bleeding group(n=72). Single factor analysis was performed on clinical data of patients in the two groups. Variables with statistical differences(age, atrial fibrillation and diastolic blood pressure) were analyzed by binary logistics regression to construct clinical prediction equations, and the discrimination and calibration degree of the equations were tested. ROC curve was used to analyze the predictive validity of the differential variables on bleeding. Stratified regression was used to analyze the mediating effect of atrial fibrillation and diastolic blood pressure on age and the presence or absence of bleeding. Results There were differences in age, atrial fibrillation and diastolic blood pressure between the intracranial hemorrhage group and the non-bleeding group. The results of binary logistics regression showed that ageatrial fibrillation and diastolic blood pressure were independent risk factors for intracranial hemorrhage after rt-PA intravenous thrombolysis. ROC curve analysis showed that age(AUC=0.692, P=0.003,diagnostic threshold value was 72.5 years old), diastolic blood pressure(AUC=0.844, P<0.001, diagnostic threshold value was 82.5mmHg) andatrial fibrillation(AUC=0.690,P=0.004) were good predictors of bleeding. Both diastolic blood pressure andatrial fibrillationwere partial mediators between age and bleeding. Conclusions High diastolic blood pressure, atrial fibrillation and old age were risk factors for intracranial hemorrhage after rt-PA intravenous thrombolysis, and adjustment of diastolic blood pressure andtreatment of atrial fibrillation before rt-PA intravenous thrombolysis might be the important means to reduce post-thrombolysis hemorrhage in the elderly.