急性脑梗死溶栓治疗后脑微出血发生现状及高危因素

Current Situation and High Risk Factors of Cerebral Microbleeding After Thrombolytic Therapy for Acute Cerebral Infarction

目的探讨急性脑梗死溶栓治疗后脑微出血发生现状及高危因素,并构建预测模型,探索其预测价值。方法回顾性分析890例2018年4月至2022年12月于安阳市第三人民医院行溶栓治疗的急性脑梗死患者的临床资料,根据是否发生脑微出血分为脑微出血组(223例)和无脑微出血组(667例)。统计急性脑梗死溶栓治疗后脑微出血发生现状及单因素,使用多因素logistic回归分析急性脑梗死溶栓治疗后脑微出血的高危因素,并建立相关预测模型,采用受试者工作特征(ROC)曲线分析预测模型对急性脑梗死溶栓治疗后脑微出血的预测价值。结果890例行溶栓治疗的急性脑梗死患者发生脑微出血223例,脑微出血发生率为25.05%。多因素logistic回归分析结果显示,年龄≥60岁、合并高脂血症、合并高血压、合并腔隙性脑梗死、有心房颤动史、血清同型半胱氨酸(Hcy)水平偏高是急性脑梗死溶栓治疗后脑微出血的独立危险因素(OR=1.570、9.337、5.778、1.923、2.000、2.596,P<0.05)。构建预测模型,ROC曲线分析结果显示,当logit(P)>9.86时,曲线下面积(AUC)值为0.877,95%CI为0.853~0.898,敏感度为89.69%,特异度为68.97%。结论行溶栓治疗的急性脑梗死患者存在脑微出血现象,其脑微出血发生的高危因素与患者年龄≥60岁、合并高脂血症、合并高血压、合并腔隙性脑梗死、有心房颤动史、血清Hcy水平偏高密切相关,据此构建的预测模型可较准确地预测急性脑梗死溶栓治疗后脑微出血,临床应用价值较高。

Objective To explore the current situation and high risk factors of cerebral microbleeding after thrombolytic therapy for acute cerebral infarction,and to establish a predictive model to explore its predictive value.Methods The clinical data of 890 patients with acute cerebral infarction who underwent thrombolytic therapy in Anyang Third People’s Hospital from April 2018 to December 2022 were retrospectively analyed.They were divided into two groups based on whether there was cerebral microbleeding:the cerebral microbleeding group(223 cases)and the non cerebral microbleeding group(667 cases).The current situation and single factor of cerebral microbleeding after thrombolytic therapy for acute cerebral infarction were conducted.The high risk factors of cerebral microbleeding after thrombolytic therapy for acute cerebral infarction were analyzed by multivariate logistic regression analysis,and relevant prediction models were established.The predictive value of the prediction model for cerebral microbleeding after thrombolytic therapy for acute cerebral infarction was analyzed using the receiver operating characteristic(ROC)curve.Results Two hundred and twenty-three patients with acute cerebral infarction who underwent thrombolytic therapy in 890 cases developed cerebral microhemorrhage,with an incidence of 25.05%.Multivariate logistic regression analysis showed that age≥60 years,with hyperlipidemia,hypertension,lacunar infarction,atrial fibrillation history,and high level of serum homocysteine(Hcy)were independent risk factors for cerebral microbleeding after thrombolytic therapy for acute cerebral infarction(OR=1.570,9.337,5.778,1.923,2.000,2.596,P<0.05).The prediction model was constructed,and the ROC curve analysis results showed that when logit(P)>9.86,the area under the curve(AUC)value was 0.877,with a 95%CI of 0.853-0.898,a sensitivity of 89.69%,and a specificity of 68.97%.Conclusion Acute cerebral infarction patients underwent thrombolytic therapy has the phenomenon of cerebral microbleeding,and the high risk factors for the occurrence of cerebral microbleeding are closely related to the age≥60 years,with hyperlipidemia,hypertension,lacunar infarction,atrial fibrillation history,and high level of serum Hcy.The prediction model constructed based on this could accurately predict cerebral microbleeding after thrombolytic therapy for acute cerebral infarction,with high clinical application value.