中国北方 6 小时内急性缺血性脑卒中静脉溶栓后症状性颅内出血的预测因素：一项多中心回顾性研究。
Predictors for symptomatic intracranial hemorrhage after intravenous thrombolysis with acute ischemic stroke within 6 h in northern China: a multicenter, retrospective study.
机构信息
Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Jinan, Shandong, 250021, PR China.
Department of Emergency, Linyi People's Hospital Affiliated to Shandong University, Lin yi, Shandong, China.
出版信息
BMC Neurol. 2022 Jan 3;22(1):6. doi: 10.1186/s12883-021-02534-9.
BACKGROUND AND PURPOSE
This study assessed the predictive factors for symptomatic intracranial hemorrhage (sICH) in patients with acute ischemic stroke (AIS) after receiving intravenous thrombolysis (IVT) within 6 h in northern China.
METHODS
We retrospectively analyzed ischemic stroke patients who were treated with IVT between November 2016 and December 2018 in 19 hospitals in Shandong Province, China. Potential predictors of sICH were investigated using univariate and multivariate analyses.
RESULTS
Of the 1293 enrolled patients (845 men, aged 62 ± 11 years), 33 (2.6%) developed sICH. The patients with sICH had increased coronary heart disease (36.4% vs. 13.7%, P = 0.001), more severe stroke (mean National Institutes of Health Stroke Scale [NIHSS] score on admission of 14 vs.7, P < 0.001), longer door-to-needle time [DNT] (66 min vs. 50 min, P < 0.001), higher blood glucose on admission, higher white blood cell counts (9000/mm vs. 7950/mm, P = 0.004) and higher neutrophils ratios (73.4% vs. 67.2%, P = 0.006) et al. According to the results of multivariate analysis, the frequency of sICH was independently associated with the NIHSS score (OR = 3.38; 95%CI [1.50-7.63]; P = 0.003), DNT (OR = 4.52; 95%CI [1.69-12.12]; P = 0.003), and white blood cell count (OR = 3.59; 95%CI [1.50-8.61]; P = 0.004). When these three predictive factors were aggregated, compared with participants without any factors, the multi-adjusted odds ratios (95% confidence intervals) of sICH for persons concurrently having one, two or three of these factors were 2.28 (0.25-20.74), 15.37 (1.96-120.90) and 29.05 (3.13-270.11), respectively (P for linear trend < 0.001), compared with participants without any factors.
CONCLUSION
NIHSS scores higher than 10 on admission, a DNT > 50 min, and a white blood cell count ≥9000/mm were independent risk factors for sICH in Chinese patients within 6 h after IVT for AIS.
背景与目的
本研究评估了在中国北方，在 6 小时内接受静脉溶栓（IVT）治疗的急性缺血性脑卒中（AIS）患者发生症状性颅内出血（sICH）的预测因素。
方法
我们回顾性分析了 2016 年 11 月至 2018 年 12 月在中国山东省 19 家医院接受 IVT 治疗的缺血性脑卒中患者。使用单变量和多变量分析来研究 sICH 的潜在预测因素。
结果
在纳入的 1293 例患者（845 例男性，年龄 62±11 岁）中，有 33 例（2.6%）发生了 sICH。sICH 患者的冠心病发生率更高（36.4% vs. 13.7%，P=0.001），卒中严重程度更严重（入院时平均国立卫生研究院卒中量表[NIHSS]评分 14 分 vs. 7 分，P<0.001），门到针时间更长[DNT]（66 分钟 vs. 50 分钟，P<0.001），入院时血糖更高，白细胞计数更高（9000/mm vs. 7950/mm，P=0.004），中性粒细胞比例更高（73.4% vs. 67.2%，P=0.006）等。根据多变量分析的结果，sICH 的发生频率与 NIHSS 评分（比值比[OR]：3.38；95%置信区间[CI]：1.50-7.63；P=0.003）、DNT（OR：4.52；95%CI：1.69-12.12；P=0.003）和白细胞计数（OR：3.59；95%CI：1.50-8.61；P=0.004）独立相关。当将这三个预测因素汇总时，与无任何因素的参与者相比，同时存在一个、两个或三个这些因素的 sICH 患者的多调整比值比（95%置信区间）分别为 2.28（0.25-20.74）、15.37（1.96-120.90）和 29.05（3.13-270.11）（P 值<0.001），与无任何因素的参与者相比。
结论
入院时 NIHSS 评分>10 分、DNT>50 分钟和白细胞计数≥9000/mm 是中国患者在 AIS 后 6 小时内接受 IVT 治疗后发生 sICH 的独立危险因素。
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