HAT评分与中性粒细胞/淋巴细胞比值联合预测急性缺血性卒中患者静脉溶栓后有症状颅内出血

Combined HAT score and neutrophil to lymphocyte ratio predict symptomatic intracranial hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke

目的探讨溶栓后出血(hemorrhage after thrombolysis,HAT)评分与中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合预测急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后有症状颅内出血(symptomatic intracranial hemorrhage,sICH)的价值。方法回顾性纳入2016年1月至2021年12月期间在天津市泰达医院接受阿替普酶静脉溶栓的连续AIS患者。sICH定义为静脉溶栓后头颅CT显示颅内任何部位出血,且美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分较基线增加≥4分或出现提示临床加重的表现。应用单变量分析比较sICH组与非sICH组基线资料。采用二分类多变量logistic回归模型确定sICH的独立影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估HAT评分与NLR联合预测sICH的价值。结果共纳入429例AIS患者。单变量分析显示,sICH组与非sICH组之间的心房颤动、收缩压、NLR、HAT评分和NIHSS评分差异有统计学意义(P均<0.05)。多变量分析显示,校正心房颤动和收缩压后,NLR[优势比(odds ratio,OR)1.405,95%置信区间(confidence interval,CI)1.193~2.958]、HAT评分(OR 1.512,95%CI 1.207~3.169)和NIHSS评分(OR 1.221,95%CI 1.082~2.634)与sICH存在显著独立相关性。ROC曲线显示,HAT评分、NLR及其二者联合预测sICH的曲线下面积分别为0.719(95%CI 0.609~0.832)、0.723(95%CI 0.618~0.835)和0.854(95%CI 0.765~0.931),二者联合预测的ROC曲线下面积显著大于单独预测(P分别为0.029和0.032),其敏感性和特异性分别为74.1%和83.5%。结论 HAT评分与NLR联合预测AIS患者静脉溶栓后sICH的价值较高,具有临床应用潜力。

Objective To investigate the value of hemorrhage after thrombolytic(HAT)score and neutrophil to lymphocyte ratio(NLR)in combination predicting symptomatic intracerebral hemorrhage(sICH)after intravenous thrombolysis in patients with acute ischemic stroke(AIS).Methods Consective patients with AIS received intravenous thrombolysis with ateplase in Tianjin TEDA Hospital from January 2016 to December 2021 were retrospectively enrolled.sICH was defined as cerebral CT showing hemorrhage at any part of the brain after intravenous thrombolysis,and the National Institutes of Health Stroke Scale(NIHSS)score was increased by≥4 compared with the baseline,or there was a manifestation indicating clinical aggravation.Univariate analysis was used to compare the baseline data of sICH group and non-sICH group.A binary multivariate logistic regression model was used to determine the independent influencing factors of sICH.The receiver operating characteristic(ROC)curve was used to evaluate the value of HAT score and NLR in combination predicting sICH.Results A total of 429 patients with AIS were enrolled.Univariate analysis showed that there were significant differences in atrial fibrillation,systolic blood pressure,NLR,HAT score and NIHSS score between the sICH group and the non-sICH group(all P<0.05).Multivariate analysis showed that NLR(odds ratio[OR]1.405,95%confidence interval[CI]1.193-2.958),HAT score(OR 1.512,95%CI 1.207-3.169)and NIHSS score(OR 1.221,95%CI 1.082-2.634)had significant independent correlation with sICH after adjusting for atrial fibrillation and systolic blood pressure.The ROC curve showed that the areas under the curve of HAT score,NLR and their combination predicting sICH were 0.719(95%CI 0.609-0.832),0.723(95%CI 0.618-0.835)and 0.854(95%CI 0.765-0.931),respectively.The areas under the curve of the two methods in combination were significantly larger than those of the single method(P=0.029 and 0.032,respectively),and their sensitivity and specificity were 74.1%and 83.5%respectively.Conclusion Combined HAT score and NLR is of high value in predicting sICH after intravenous thrombolysis in patients with AIS,and has clinical application potential.