急性脑梗死机械取栓术后出血性转化的发生率及危险因素

Incidence of hemorrhagic transformation after mechanical thrombectomy for acute cerebral infarction and its risk factors

目的探讨急性脑梗死(ACI)机械取栓术后出血性转化(HT)的发生率及危险因素。方法分析2022年1月至2023年12月梅州市人民医院接受机械取栓的125例ACI患者临床资料,统计ACI患者机械取栓后HT发生率。根据是否发生HT分为HT组和非HT组。分析机械取栓后发生HT的危险因素。结果125例ACI患者机械取栓后发生HT患者38例,发生率为30.4%。HT组年龄≥60岁、糖尿病、大面积脑梗死、美国国立卫生研究院卒中表评分(NIHSS)评分≥15分、取栓次数>2次患者比例高于非HT组(^(均)P<0.05),HT组患者外周血NLR水平高于非HT组(P<0.05)。多因素Logistic回归显示,年龄、糖尿病、大面积脑梗死、NIHSS评分≥15分、取栓次数>2次和外周血NLR≥5.73是ACI患者机械取栓后发生HT的重要危险因素(~均P<0.05)。根据多因素Logistic回归构建机械取栓后HT的预测模型,Logit(P)=-5.696+1.326×年龄+1.894×糖尿病+1.526×大面积脑梗死+2.243×NIHSS评分+3.610×取栓次数+2.660×NLR。该预测模型评估HT发生的受试者工作特征(ROC)曲线下面积为0.913(95%CI:0.861~0.965),敏感度为89.5%,特异度为80.5%。结论ACI患者机械取栓后HT发病率较高,年龄、糖尿病、大面积脑梗死、NIHSS评分、取栓次数和外周血NLR水平与ACI患者机械取栓后HT的发生有关,构建危险因素预测模型有助于早期评估HT发生风险。

Objective To investigate the incidence of hemorrhagic transformation(HT)after mechanical thrombectomy for acute cerebral infarction(ACI)and its risk factors.Methods The clinical data of 125 patients with ACI who received mechanical thrombectomy from January 2022 to December 2023 were retrospectively analyzed,and the incidence of HT in ACI patients after mechanical thrombectomy was analyzed.They were divided into HT group and non-HT group according to whether HT occurred or not.The risk factors of HT after mechanical thrombectomy were analyzed.Results Of 125 ACI patients,38 cases developed HT after mechanical thrombectomy(30.4%).The proportion of patients with age≥60 years old,diabetes mellitus,large area cerebral infarction,NIHSS score≥15 and thrombectomy times>2 times in HT group was higher than that in non-HT group(all P<0.05),and the level of peripheral blood NLR in HT group was higher than that in non-HT group(P<0.05).Multivariate Logistic regression showed that age,diabetes,large area cerebral infarction,NIHSS score≥15,number of thrombectomy>2and peripheral blood NLR≥5.73 were important risk factors for HT after mechanical thrombectomy in ACI patients(all P<0.05).The prediction model of HT after mechanical thrombectomy was constructed according to multivariate Logistic regression.Logit(P)=-5.696+1.326×age+1.894×diabetes+1.526×large cerebral infarction+2.243×NIHSS score+3.610×thrombectomy times+2.660×NLR.The area under ROC curve of the prediction model was 0.913(95%CI:0.861-0.965),the sensitivity was 89.5%,and the specificity was 80.5%.Conclusion The incidence of HT after mechanical thrombectomy is higher in patients with ACI.Age,diabetes mellitus,large area cerebral infarction,NIHSS score,number of thrombectomy and peripheral blood NLR level are related to the occurrence of HT after mechanical thrombectomy in patients with ACI.Establishing a risk factor prediction model is helpful for early assessment of the risk of HT.