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目的比较5种风险量表对急性脑梗死(AIS)患者静脉溶栓后症状性脑出血(sICH)与不良转归的预测价值。方法选择发病4.5h内接受重组组织型纤溶酶原激活剂静脉溶栓的AIS患者202例,用多中心脑卒中调查评分;年龄和美国国立卫生研究院卒中量表(NIHSS)的脑卒中预测评分;基线血糖、头颅CT早期脑梗死征、高密度血管征、年龄和NIHSS组合评分;血管事件健康风险汇总评分(THRIVE);入院血糖、种族、年龄、性别、入院收缩压、脑卒中严重程度组合评分等分别预测静脉溶栓后sICH与不良转归。用ROC曲线下面积(AUC)衡量量表预测能力。根据最大Youden指数的最佳量表截点值,将患者分为低危组(THRIVE≤3分)99例和高危组(THRIVE≥4分)103例,探讨分组与90d不良预后的关系。结果 5种风险量表预测sICH的AUC<0.8;THRIVE预测静脉溶栓后90d内死亡和不良预后的AUC最高(AUC=0.833,95%CI:0.768~0.893;AUC=0.813,95%CI:0.754~0.872)。THRIVE评分高危组较低危组90d不良预后更高(OR=11.498,95%CI:5.470~24.167,P<0.01)。结论5种风险量表对AIS静脉溶栓后sICH预测能力一般,THRIVE评分对90d不良转归预测能力较好。
Objective To compare the predictive value of five risk scales for symptomatic intracerebral hemorrhage (sICH) and adverse outcomes after intravenous thrombolysis in patients with acute cerebral infarction (AIS). Methods Totally 202 AIS patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours of onset were enrolled in this study. The multicentre stroke scores, age, and stroke predicted by National Institutes of Health Stroke Scale (NIHSS) Score, baseline blood glucose, head CT early cerebral infarction sign, high density vascular sign, age and NIHSS combined score; vascular health risk summary score (THRIVE); admission blood glucose, race, age, gender, admission systolic pressure, stroke severity Combined score, etc. were predicted sICH and venous thrombolysis after adverse outcomes. The area under the ROC curve (AUC) is used to measure the scale predictive power. The patients were divided into 99 cases of low risk group (THRIVE≤3 points) and 103 cases of high risk group (THRIVE≥4 points) according to the best Youden index cutoff value. The relationship between grouping and 90d adverse prognosis was explored. Results The AUC of sICH for the five risk scales was <0.8; THRIVE predicted the highest AUC for death and poor prognosis within 90 days after intravenous thrombolysis (AUC = 0.833, 95% CI: 0.768-0.893; AUC = 0.813, 95% CI: 0.754 ~ 0.872). The poor prognosis was higher in the THRIVE high-risk group than in the low-risk group at 90 days (OR = 11.498, 95% CI: 5.470-24.167, P <0.01). Conclusion The five risk scales have a good predictive ability for sICH after AIS intravenous thrombolysis, and the THRIVE score has good predictive value for the 90-day adverse outcome.