中国卒中杂志 ›› 2019, Vol. 14 ›› Issue (06): 533-540.DOI: 10.3969/j.issn.1673-5765.2019.06.004

• 论著 • 上一篇    下一篇

探讨ASPECTS、DRAGON和SEDAN评分对我国急性缺血性卒中患者静脉溶栓后急性期内出血转化的预测价值

郑国将,毛相濡,丁刚玉,王星,徐建华,靳令经,聂志余   

  1. 1201000 上海健康医学院附属嘉定区中心医院神经内科
    2同济大学附属同济医院神经内科
  • 收稿日期:2019-01-01 出版日期:2019-06-20 发布日期:2019-06-20
  • 通讯作者: 聂志余 nzhiyu2002@sina.com

Predictive Value of ASPECTS, DRAGON and SEDAN Scores for Hemorrhagic Transformation after Intravenous Thrombolysis in Patients with Acute Ischemic Stroke in China

  • Received:2019-01-01 Online:2019-06-20 Published:2019-06-20

摘要:

目的 探讨Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)、DRAGON 评分和SEDAN评分对我国急性缺血性卒中患者静脉溶栓后急性期内出血转化的预测价值。 方法 回顾性连续收集2012年12月-2017年12月在同济大学附属同济医院神经内科急诊收入的接 受静脉溶栓治疗的急性缺血性卒中患者的临床资料,记录有关基线资料,并使用ASPECTS、DRAGON 和SEDAN 3个量表进行评分。以住院期间出血转化作为观察终点。应用受试者工作特征(receiver operating characteristic,ROC)曲线评估量表对静脉溶栓后出血转化的预测诊断价值,ROC曲线下面积 采用C值表示,通过C值比较3个量表的预测价值;使用Hosmer-Lemeshow(H-L)拟合优度[χ 2(P)]检验 法判断各模型与实际结果的拟合度;进行Logistic回归分析探讨各评分与溶栓后出血转化的关系。 结果 共纳入199例患者,ASPECTS、DRAGON和SEDAN评分在总体患者中C值分别为0.889、0.810和 0.793;前循环中C值分别为0.889、0.823和0.788;男性组中C值分别为0.893、0.788和0.818;女性组中 C值分别为0.882、0.808和0.720(均P <0.05)。ASPECTS、DRAGON和SEDAN评分在总体患者中H-L拟合 优度检验结果分别为8.253、2.685和7.511;在前循环中分别为9.875、4.330和6.441;在男性组中分别 为8.966、1.697和3.049;在女性组中分别为4.284、6.548和7.669(仅前循环和男性组的ASPECTS评分P <0.05,余P>0.05)。Logistic回归分析ASPECTS、DRAGON和SEDAN评分的OR 值在总体患者分别为0.588、 1.839和2.229,在前循环分别为0.567、1.951和2.198,在男性组分别为0.595、1.969和2.675,在女性 组分别为0.573、1.833和1.787(均P <0.05)。 结论 ASPECTS、DRAGON和SEDAN评分量表均可用于急性缺血性卒中患者静脉溶栓后出血转化风 险的预测,ASPECTS评分要优于另外2种评分模型。

文章导读: 本研究再次证实了ASPECTS、DRAGON和SEDAN评分能有效预测急性缺血性卒中患者静脉溶栓后出血转化,其中ASPECTS评分预测价值高于其他两种评分。

关键词: 缺血性卒中; 静脉溶栓; 出血转化; 预测模型

Abstract:

Objective To investigate the predictive value of ASPECTS, DRAGON and SEDAN scores for hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke (AIS). Methods The baseline data of consecutive AIS patients treated with intravenous thrombolysis from Department of Neurology of Tongji Hospital of Tongji University from December 2012 to December 2017 were retrospectively collected, and all patients were scored with ASPECTS, DRAGON and SEDAN scales. The primary endpoint was hemorrhagic transformation during hospitalization. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of the three scales, and the area under the ROC curve was expressed by C value; the goodness of fit of the three scales were judged by Hosmer-Lemeshow (H-L) goodness-offit test; and the correlation between the three scales and outcome events was evaluated by logistic regression analysis. Results A total of 199 patients were included in this study. The C value of ASPECTS, DRAGON and SEDAN scores in all patients were 0.889, 0.810 and 0.793, respectively; in anterior circulation were 0.889, 0.823 and 0.788, respectively; in male patients were 0.893, 0.788 and 0.818, respectively; in female patients were 0.882, 0.808 and 0.720, respectively (all P <0.05). The χ2 value of H-L goodness-of-fit test of the three scales in all patients were 8.253, 2.685 and 7.511, respectively; in anterior circulation were 9.875, 4.330 and 6.441, respectively; in male patients were 8.966, 1.697 and 3.049, respectively; in female patients were 4.284, 6.548 and 7.669, respectively (P <0.05 were only for ASPECTS in anterior circulation and male groups, and all the rest P >0.05). The OR in logistic regression analysis of the three scales in all patients were 0.588, 1.839 and 2.229, respectively; in anterior circulation were 0.567, 1.951, 2.198, respectively; in male patients were 0.595, 1.969 and 2.675, respectively; in female patients were 0.573, 1.833 and 1.787, respectively (all P <0.05). Conclusions ASPECTS, DRAGON and SEDAN scales all have strong predictive ability for the risk of hemorrhagic transformation after intravenous thrombolysis in AIS patients, and ASPECTS is superior to the other two prediction models.

Key words: Ischemic stroke; Intravenous thrombolysis; Hemorrhagic transformation;Prediction model