应激性血糖升高比值联合糖化血红蛋白水平对老年急性缺血性脑卒中病人静脉溶栓后出血转化的预测价值

Predictive value of stress hyperglycemia ratio combined with glycosylated hemoglobin on hemorrhagic transformation after intravenous thrombolysis in elderly patients with acute ischemic stroke

目的 探讨应激性血糖升高比值(SHR)联合HbA1c对老年急性缺血性脑卒中(AIS)病人静脉溶栓后出血转化(HT)的预测价值。方法 纳入2018年6月至2020年12月连云港市第一人民医院和江苏大学附属医院接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓AIS老年住院病人共234例,依据急性期内复查CT或MRI结果,将病人分为HT组(n=50)和非HT组(n=184)。收集并比较2组病人临床基线资料。采用多因素Logistic回归分析老年AIS病人rt-PA静脉溶栓后HT的危险因素,应用ROC曲线分析SHR、HbA1c及二者联合预测老年AIS病人rt-PA后HT的价值。结果 2组年龄、溶栓前NIHSS评分、FPG、HbA1c水平,房颤、TOAST分型和梗死大面积比例差异均有统计学意义(P<0.05或P<0.01)。多因素Logistic回归分析结果表明:高水平SHR(OR=39.443,95%CI:1.847~842.343)、HbA1c(OR=1.777,95%CI:1.091~2.859)以及大面积梗死(OR=3.093,95%CI:1.359~7.036)是老年AIS病人rt-PA静脉溶栓后HT的独立危险因素。HbA1c、SHR及二者联合预测老年AIS病人rt-PA静脉溶栓后HT风险的AUC分别为:0.631(95%CI:0.541~0.721)、0.656(95%CI:0.654~0.748)、0.741(95%CI:0.665~0.816)。HbA1c联合SHR预测的AUC显著大于两指标单独预测,差异有统计学意义(P均<0.05)。结论 高水平SHR和HbA1c是老年AIS病人rt-PA静脉溶栓后HT的独立危险因素,两者联合可更好地预测老年AIS病人rt-PA静脉溶栓后HT风险。

Objective To investigate the predictive value of stress hyperglycemia ratio(SHR)combined with glycosylated hemoglobin(HbA1c)on hemorrhagic transformation(HT)after intravenous thrombolysis in the elderly patients with acute ischemic stroke(AIS).Methods A total of 234 elderly AIS inpatients receiving intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA)from the First People’s Hospital of Lianyungang and Affiliated Hospital of Jiangsu University from June 2018 to December 2020 were enrolled in this study.The patients were divided into HT group(n=50)and non-HT group(n=184)according to the results of computed tomography(CT)or magnetic resonance imaging(MRI)during the acute period.The clinical baseline data of the two groups were collected and compared.Multivariate Logistic regression analysis was used to analyze the risk factors for HT after rt-PA intravenous thrombolytic therapy in the elderly AIS patients.The receiver operating characteristic(ROC)curve was used to analyze the value of SHR,HbA1c and their combination in predicting HT after rt-PA intravenous thrombolytic therapy in the elderly AIS patients.Results There were statistically significant differences in age,pre-thrombolysis NIHSS score,the levels of fasting plasma glucose(FPG)and HbA1c,and the ratio of atrial fibrillation,TOAST classification and large infarct area between the two groups(P<0.05 or P<0.01).Multivariate Logistic regression analysis showed that high levels of SHR(OR=39.443,95%CI:1.847-842.343)and HbA1c(OR=1.777,95%CI:1.091-2.859),and large infarct area(OR=3.093,95%CI:1.359-7.036)were the independent risk factors for HT after intravenous thrombolysis with rt-PA in the elderly AIS patients.The area under curve(AUC)of HbA1c,SHR and their combination to predict the risk of HT after intravenous thrombolysis with rt-PA in the elderly AIS patients was 0.631(95%CI:0.541-0.721),0.656(95%CI:0.654-0.748)and 0.741(95%CI:0.665-0.816),respectively.The AUC of HbA1c combined with SHR was significantly greater than that of the two indexes alone(P<0.05).Conclusions High levels of SHR and HbA1c are independent risk factors for HT after intravenous thrombolysis with rt-PA in the elderly AIS patients,and the combination of the two indexes shows significant value to predict the risk of HT after rt-PA intravenous thrombolytic therapy.