Page 90 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第12期
·1796 · Journal of Nanjing Medical University（Natural Sciences） 2021年12月

·临床医学·

超时间窗急性缺血性脑卒中患者动脉取栓后颅内出血预警模

型构建

包建英，王雪梅 ，曹月洲，刘 圣，施海彬
*
南京医科大学第一附属医院介入放射科，江苏 南京 210029

［摘 要］ 目的：分析超时间窗急性缺血性脑卒中（acute ischemic stroke，AIS）患者动脉取栓后颅内出血的危险因素，建立预警
模型以指导临床。方法：回顾性分析2018年1月—2020年6月接受动脉取栓治疗的146例超时间窗AIS患者的临床资料，依据
是否发生颅内出血转化分为出血组和非出血组，比较两组患者的人口学、临床和影像资料。采用Logistic回归分析动脉取栓后
颅内出血的危险因素并建立预警模型。采用受试者工作特性（receiver operator characteristic，ROC）曲线评估预警模型对动脉
取栓后颅内出血的预测效能。结果：48例（32.9%）出现颅内出血。与非出血组比较，出血组基线美国国立卫生研究院脑卒中
量表（NIHSS）评分更高（P < 0.001）、支架取栓次数更多（P=0.049）、基线 Alberta 卒中项目早期 CT（ASPECT）评分更低（P <
0.001）。Logistic回归显示，高NIHSS评分（P=0.001）和低ASPECT评分（P < 0.001）是出血转化的危险因素。预警模型为：颅内
出血风险值=-0.535+0.130×NIHSS评分-0.597×ASPECT评分。模型预测取栓后颅内出血的ROC曲线下面积灵敏度和特异度
分别为0.875、0.854和0.837。结论：高基线NIHSS 评分和低基线ASPECT 评分是超时间窗AIS患者动脉取栓后发生颅内出血
的危险因素。预警模型可为超时间窗AIS患者动脉取栓后的临床观察和出血转化防治提供依据。
［关键词］ 急性缺血性脑卒中；时间窗；动脉取栓；颅内出血；预警模型
［中图分类号］ R743.31 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）12⁃1796⁃05
doi：10.7655/NYDXBNS20211214

Development of predictive model for intracranial hemorrhage after intra ⁃ arterial

thrombectomy in patients with acute ischemic stroke in extended time window
*
BAO Jianying，WANG Xuemei ，CAO Yuezhou，LIU Sheng，SHI Haibin
Department of Intervention Radiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
China

［Abstract］ Objective：This study aims to analyze the risk factors of intracranial hemorrhage（IH）in patients with acute ischemic
stroke（AIS）treated with intra⁃arterial thrombectomy（IAT）in extended time window，and to establish the predictive model for guiding
clinical decision. Methods：From January 2018 and June 2020，clinical data of 146 AIS patients treated with IAT in extended time
window were retrospectively analyzed. Patients were divided into hemorrhage and no⁃hemorrhage group. Demographic，clinical and
imaging data were compared between two groups. Logistic regression（LR）analysis was applied to clarify the risk factor of IH after IAT，
and to establish the predictive model. Receiver operator characteristic curve（ROC）analysis was used to evaluate the performance of
the model for predicting IH after IAT. Results：IH occurred in 48（32.9%）patients. Compared with no⁃hemorrhage group，hemorrhage
group showed higher baseline National Institute of Health stroke scale（NIHSS）（P < 0.001），higher numbers of stent thrombectomy（P=
0.049）and lower baseline alberta stroke program early computed tomography score（ASPECTS）（P < 0.001）. LR analysis indicated
that，high NIHSS（P=0.001）and low ASPECTS（P < 0.001）were risk factors of IH. The predictive model was as follows：hemorrhage
risk value =-0.535+0.130×NIHSS-0.597×ASPECTS. The predictive model showed an area under the ROC curve，sensitivity and
specificity of 0.875，0.854 and 0.837，respectively. Conclusion：In the AIS patients in extended time window，the patients with high
baseline NIHSS and low ASPECTS were prone to IH after IAT. The predictive model can provide reference for prevention of IH and
clinical observation.
［Key words］ acute ischemic stroke；time window；intra⁃arterial thrombectomy；intracranial hemorrhage；predictive model
［基金项目］ 国家自然科学基金（81971613） ［J Nanjing Med Univ，2021，41（12）：1796⁃1800］
∗
通信作者（Corresponding author），E⁃mail： treebranch701@sina.com