ASPECTS评分在急性脑梗死患者阿替普酶溶栓后出血转化评估中的价值

Value of ASPECTS in Evaluating Hemorrhagic Transformation after Alteplase Thrombolysis in Patients with Acute Cerebral Infarction

【目的】探讨Alberta卒中项目早期CT评分(ASPECTS)在急性脑梗死(ACI)患者阿替普酶溶栓后出血转化评估中的价值。【方法】92例采用阿替普酶溶栓治疗的ACI患者,均于初诊时行头颅CT平扫,观察患者溶栓后出血转化发生情况,并据此分为出血转化组和非出血转化组。比较两组ASPECTS评分及相关临床资料,通过受试者工作特征(ROC)曲线分析ASPECTS评分评估患者溶栓后出血转化发生风险的价值,采用多因素Logistic回归分析出血转化的影响因素。【结果】92例溶栓治疗的ACI患者经头颅CT检查出现出血性脑梗死1型11例、2型3例;实质性血肿1型10例、2型2例,共26例(28.26%)纳入出血转化组;66例(71.74%)纳入非出血转化组。出血转化组发生心房颤动的患者占比及美国国立卫生研究院卒中量表(NIHSS)评分高于非出血转化组(P<0.05),ASPECTS评分低于非出血转化组(P<0.05)。经ROC曲线分析显示,ASPECTS评分可用于评估ACI患者溶栓后出血转化的发生风险,敏感度为80.32%,特异度为79.02%。多因素Logistic回归分析显示,心房颤动、NIHSS评分、ASPECTS评分均为患者溶栓后出血转化发生的独立影响因素(P<0.05)。【结论】ACI患者阿替普酶溶栓后出血转化发生风险较高,ASPECTS评分可作为早期预测出血转化发生的有效指标,评分越低提示出血转化发生风险越高。

【Objective】To investigate the value of the Alberta Stroke Program Early CT Score(ASPECTS)in evaluating hemorrhagic transformation(HT)after alteplase thrombolysis in patients with acute cerebral infarction(ACI).【Methods】A total of 92 ACI patients treated with alteplase thrombolysis underwent cranial CT scans at initial diagnosis.The occurrence of HT after thrombolysis was observed,and patients were divided into the HT group and non-HT group accordingly.ASPECTS scores and related clinical data of the two groups were compared.The value of ASPECTS in assessing the risk of HT after thrombolysis was analyzed using the receiver operating characteristic(ROC)curve,and multivariate logistic regression was used to analyze the influencing factors of HT.【Results】Among the 92 ACI patients treated with thrombolysis,11 had type 1 and 3 had type 2 of hemorrhagic infarction,while 10 had parenchymal hematoma type 1 and 2 had parenchymal hematoma type 2.So there were a total of 26 cases(28.26%)in the HT group.The rest 66 cases(71.74%)without HT were included in the non-HT group.The proportion of patients with atrial fibrillation and National Institutes of Health Stroke Scale(NIHSS)scores in the HT group were higher than that in the non-HT group(P<0.05),and the ASPECTS scores were lower in the HT group than in the non-HT group(P<0.05).ROC analysis confirmed that ASPECTS could be used to assess the risk of HT after thrombolysis in ACI patients,with a sensitivity of 80.32%and a specificity of 79.02%.Multivariate logistic regression analysis showed that atrial fibrillation,NIHSS score,and ASPECTS score were independent influencing factors for HT after thrombolysis(P<0.05).【Conclusion】The risk of HT after alteplase thrombolysis is high in ACI patients.ASPECTS can be used as an effective early predictor of HT occurrence:the lower the score,the higher the risk of HT.