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[目的]探索HAT评分(溶栓后出血评分)与使用rt-PA(0.6mg/kg体重)静脉溶栓治疗脑梗死后颅内出血情况的关系,为使用HAT指导溶栓治疗做准备。[方法]对162名进行了重组组织型纤溶酶原激活剂(rt-PA,按0.6mg/kg体重)静脉溶栓的急性前循环脑梗死患者,分别记录HAT评分的各分项评分情况,按HAT0分、1分、2分、3分和≥4分为5组,记录各组患者的溶栓后颅内出血情况(分为非症状性、症状性及致死性颅内出血)和90d后的功能结局(以改良Rankin评分,mRs表示),各组间进行比较。[结果]HAT0分、1分、2分、3分和≥4分各组的总颅内出血的百分比分别为2.7%、10.2%、20.0%、31.2%和50.0%;症状性颅内出血的比例分别为0.0%、2.0%、5.0%、12.6%和50.0%,卡方检验得χ2=28.0,P﹤0.001(Monte Carlo确切概率法),提示HAT分值的增加,颅内出血的比例及严重程度在增加,存在统计学上的差异。另外将HAT和出血类型做spearman等级相关分析,得到spearman相关系数0.306,P﹤0.001;说明HAT得分和出血程度正相关。本研究患者队列的症状性出血比例为3.1%,低于NINDS研究的5.9%。随着HAT评分的增加,取得良好预后(mRs≤2的比例)的可能性越来越小。[结论]对于按0.6mg/kg体重,时间窗为4.5h使用rt-PA进行静脉溶栓的急性脑梗死患者,HAT评分的增加与颅内出血风险的增加正相关。HAT可能作为预测溶栓后颅内出血风险的一个简单易行的实用临床工具。
[Objective] To explore the relationship between HAT score (bleeding score after thrombolysis) and intracranial hemorrhage after intravenous thrombolysis with rt-PA (0.6mg / kg body weight) for cerebral infarction in preparation for the use of HAT for guiding thrombolytic therapy. [Methods] A total of 162 acute anterior circulation cerebral infarction patients who underwent intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA, 0.6 mg / kg body weight) were enrolled. The scores of each component of HAT score The patients were divided into 5 groups according to HAT0, 1, 2, 3 and ≥4, intracranial hemorrhage after thrombolysis was recorded in each group (non-symptomatic, symptomatic and fatal intracranial hemorrhage) and 90 days Functional outcome (modified Rankin score, mRs) was compared between groups. [Results] The percentage of total intracranial hemorrhage in each group with HAT score of 0, 1, 2, 3 and 4 was 2.7%, 10.2%, 20.0%, 31.2% and 50.0% respectively. The proportion of symptomatic intracranial hemorrhage (P <0.001) (Monte Carlo exact probability method), suggesting that the increase in HAT score, the proportion of intracranial hemorrhage and the severity of the disease were in the range of -0.0%, 2.0%, 5.0%, 12.6% and 50.0% Increase, there is a statistical difference. In addition, spearman rank correlation analysis between HAT and hemorrhage type showed a spearman correlation coefficient of 0.306, P <0.001; indicating that HAT score was positively correlated with the degree of bleeding. The proportion of symptomatic bleeding in our cohort was 3.1%, down from 5.9% in the NINDS study. As the HAT score increases, it is less likely that a good prognosis (a ratio of mRs ≦ 2) will be achieved. [Conclusion] The increase of HAT score was positively correlated with the increased risk of intracranial hemorrhage in patients with acute cerebral infarction treated with rt-PA at 0.6 mg / kg body weight and time window of 4.5 h. HAT may serve as a simple and practical clinical tool to predict the risk of intracranial hemorrhage after thrombolysis.