系统免疫炎症指数预测老年卒中病人溶栓后出血转化的价值

Value of systemic immune inflammation index in predicting hemorrhage transformation afteRthrombolysis in elderly patients with stroke

目的评估系统免疫炎症指数(SII)对老年急性缺血性卒中(AIS)病人静脉溶栓(IVT)后出血转化(HT)的预测价值。方法回顾性收集我院2019年8月至2022年2月行IVT的347例老年AIS病人的临床资料,根据溶栓后是否出血分为HT组和无出血转化(NHT)组,并进行比较分析;计算SII值,根据ROC曲线最佳截断值721分为高SII组和低SII组;应用多因素Logistic回归探索HT的相关因素。采用改良Rankin量表(mRS)评价病人短期功能预后,使用限制性立方样条(RCS)模型评价SII与短期预后的关系。结果347例病人中有52例发生HT(15%)。HT组病人的SII显著高于NHT组(P<0.001),高SII组短期预后不良率高于低SII组(P<0.001)。RCS显示预后不良与SII呈剂量依赖关系。Logistic回归结果显示,SII与HT发生独立相关,高SII组发生HT风险是低SII组的6.65倍。ROC曲线表明,SII值在721时,对老年AIS病人HT的预测价值最高[AUC为0.784(95%CI:0.715~0.853),P<0.001]。结论SII水平增加老年AIS病人溶栓后发生HT的风险,且与短期功能预后不良相关,在临床上具有一定参考价值。

Objective To evaluate the predictive value of systemic immune inflammatory index(SII)on hemorrhage transformation(HT)afteRintravenous thrombolysis(IVT)in the elderly patients with acute ischemic stroke(AIS).Methods A total of 347 elderly patients with AIS undergoing IVT in ouRhospital from August 2019 to February 2022 were retrospectively collected.They were divided into HT group and NHT group according to whetheRthere was bleeding afteRthrombolysis,and the clinical data of the two groups were compared.SII value was calculated and the patients were divided into high SII group and low SII group according to the best cut-off value of ROC curve.Logistic regression was used to explore the risk factors of HT.The short-term functional prognosis of the elderly patients with AIS afteRIVT was evaluated by the modified Rankin scale(mRS),and the relationship between SII and functional prognosis was evaluated by the restricted cubic spline(RCS)model.Results There were 52 cases(15%)with HT.The value of SII in HT group was significantly higheRthan that in NHT group[1000.56(651.68,1531.38)vs 508.80(338.49,793.41),P<0.001].The rate of pooRshort-term prognosis in high SII group was higheRthan that in low SII group(P<0.001).RCS showed a dose-dependent relationship between short-term pooRprognosis and SII.Logistic regression showed that SII was independently associated with HT.Compared with low SII group,the risk of HT in high SII group increased by 6.65 times.ROC curve showed that when the value of SII was 721,the predictive value on HT in the elderly patients with AIS was the highest[AUC=0.784(95%CI:0.715-0.853),P<0.001].Conclusions SII increases the risk of HT in the elderly patients with AIS afteRIVT,and is associated with pooRshort-term functional prognosis.