老年急性脑梗死患者阿替普酶静脉溶栓后出血转化预测模型的建立及验证

Establishment and validation of prediction model for HT after intravenous alteplase thrombolysis in elderly patients with ACI

目的 建立并验证老年急性脑梗死患者静脉溶栓后出血转化预测模型。方法 回顾性收集2021年1月至2022年12月首都医科大学附属北京世纪坛医院神经与精神科收治的老年急性脑梗死患者180例,根据静脉溶栓后发生出血转化情况分为脑出血组48例和对照组132例。将数据集又随机分为训练集126例,验证集54例。观察2组临床特征差异,分析老年急性脑梗死患者静脉溶栓后出血转化的危险因素,并根据相关危险因素建立静脉溶栓后出血转化的Nomogram预测模型。结果 与对照组比较,脑出血组年龄≥80岁、收缩压≥180 mm Hg(1 mm Hg=0.133 kPa)、心房颤动、脑梗死面积≥3 cm^(2)比例明显升高(P<0.05,P<0.01)。多因素logistic回归分析显示,年龄≥80岁、收缩压≥180 mm Hg、心房颤动、脑梗死面积≥3 cm^(2)是静脉溶栓后出血转化的危险因素(OR=2.632,95%CI:1.153~6.005,P=0.022;OR=3.150,95%CI:1.445~6.866,P=0.004;OR=4.553,95%CI:1.561~13.283,P=0.006;OR=2.673,95%CI:1.278~5.592,P=0.009)。ROC曲线分析显示,年龄和收缩压对老年急性脑梗死患者静脉溶栓后出血转化预测的曲线下面积分别为0.702、0.609。训练集曲线下面积为0.781(95%CI:0.691~0.870),验证集曲线下面积为0.822(95%CI:0.701~0.943)。本模型具有较好的预测价值和可信度。结论 Nomogram预测模型有利于识别老年急性脑梗死患者静脉溶栓后出血转化的高危人群。

Objective To establish and validate the prediction model of hemorrhagic transformation after intravenous thrombolysis in elderly patients with acute cerebral infarction(ACI).Methods Clinical data of 180 elderly ACI patients admitted to our hospital from January 2021 to December 2022 were retrospectively collected.According to their conditions after intravenous thrombolysis,they were divided into cerebral hemorrhage group(n=48)and control group(n=132).The data set was then randomly divided into training set(126 cases)and validation set(54 cases).The clinical characteristics were compared between the two groups to analyze the risk factors of hemorrhagic transformation after intravenous thrombolysis.Then we established a nomogram model of transformation of bleeding after intravenous thrombolysis.Results The cerebral hemorrhage group had significantly larger proportions of aged≥80 years,SBP≥180 mm Hg,atrial fibrillation and cerebral infarction area≥3 cm^(2) than the control group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that age≥80 years,SBP≥180 mm Hg,atrial fibrillation and cerebral infarction area≥3 cm^(2) were risk factors for transformation of bleeding after intravenous thrombolysis in elderly ACI patients(OR=2.632,95%CI:1.153-6.005,P=0.022;OR=3.150,95%CI:1.445-6.866,P=0.004;OR=4.553,95%CI:1.561-13.283,P=0.006;OR=2.673,95%CI:1.278-5.592,P=0.009).The area under curve of the ROC for predicting the secondary hemorrhagic transformation after intravenous thrombolysis in patients with acute cerebral infarction was 0.702 and 0.609 for age and hypertension respectively.The AUC value of the training set was 0.781(95%CI:0.691-0.870),and that of the verification set was 0.822(95%CI:0.701-0.943).Our model had a good predictive value and credibility.Conclusion This nomogram model is helpful to identify the high-risk population of hemorrhagic transformation after intravenous thrombolysis in elderly ACI patients.