接受静脉溶栓治疗的急性卒中患者的全脑小血管疾病评分与脑出血风险
Total Cerebral Small Vessel Disease Score and Cerebral Bleeding Risk in Patients With Acute Stroke Treated With Intravenous Thrombolysis.
作者信息
Du Houwei, Wu Sangru, Lei Hanhan, Ambler Gareth, Werring David J, Li Hangfeng, Chen Yangui, Chen Dongping, Yuan Qilin, Fang Shuangfang, Chen Ronghua, Zhang Yixian, Wei Jin, Chen Guangliang, Chen Jianhua, Liu Nan
机构信息
Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China.
Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China.
出版信息
Front Aging Neurosci. 2022 Apr 11;14:790262. doi: 10.3389/fnagi.2022.790262. eCollection 2022.
OBJECTIVE
The aim of this study was to investigate the association of total cerebral small vessel disease (cSVD) score with the risk of intracerebral hemorrhage (ICH) in patients with acute ischemic stroke who received intravenous thrombolysis (IVT) using recombinant tissue-plasminogen activator (rt-PA).
METHODS
We retrospectively reviewed clinical data from two stroke registries of patients with acute ischemic stroke treated with IVT. We assessed the baseline magnetic resonance (MR) visible cSVD markers and total cSVD score (ranging from 0 to 4) between patients with and without ICH after IVT. Logistic regression analysis was used to determine the association of total cSVD score with the risk of ICH after IVT, adjusted for cofounders selected by least absolute shrinkage and selection operator (LASSO). We additionally performed an -value analysis to fully explain away a specific exposure-outcome association. Receiver operating characteristic (ROC) curve analysis was used to quantify the predictive potential of the total cSVD score for any ICH after IVT.
RESULTS
Among 271 eligible patients, 55 (20.3%) patients experienced any ICH, 16 (5.9%) patients experienced a symptomatic ICH (sICH), and 5 (1.85%) patients had remote intracranial parenchymal hemorrhage (rPH). Logistic regression analysis showed that the risk of any ICH increased with increasing cSVD score [per unit increase, adjusted odds ratio (OR) 2.03, 95% CI 1.22-3.41, = 0.007]. Sensitivity analyses using -value revealed that it would need moderately robust unobserved confounding to render the exposure-outcome (cSVD-any ICH) association null. ROC analysis showed that compared with the National Institutes of Health Stroke Scale (NIHSS) score alone, a combination of cSVD and NIHSS score had a larger area under the curve for any ICH (0.811, 95% CI 0.756-0.866 vs. 0.784, 95% CI 0.723-0.846, = 0.0004).
CONCLUSION
The total cSVD score is associated with an increased risk of any ICH after IVT and improves prediction for any ICH compared with NIHSS alone.
目的
本研究旨在探讨接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗（IVT）的急性缺血性脑卒中患者的全脑小血管病（cSVD）总分与脑出血（ICH）风险之间的关联。
方法
我们回顾性分析了两个急性缺血性脑卒中患者IVT治疗的卒中登记处的临床资料。我们评估了IVT后发生ICH和未发生ICH的患者之间基线磁共振（MR）可见的cSVD标志物和cSVD总分（范围为0至4）。采用逻辑回归分析确定IVT后cSVD总分与ICH风险之间的关联，并对通过最小绝对收缩和选择算子（LASSO）选择的混杂因素进行校正。我们还进行了e值分析以充分解释特定暴露-结局关联。采用受试者工作特征（ROC）曲线分析来量化IVT后cSVD总分对任何ICH的预测潜力。
结果
在271例符合条件的患者中，55例（20.3%）发生了任何类型的ICH，16例（5.9%）发生了症状性ICH（sICH），5例（1.85%）发生了远隔颅内实质出血（rPH）。逻辑回归分析显示，任何ICH的风险随着cSVD评分的增加而增加[每单位增加，校正比值比（OR）2.03，95%可信区间1.22-3.41，P = 0.007]。使用e值的敏感性分析表明，需要适度强大的未观察到的混杂因素才能使暴露-结局（cSVD-任何ICH）关联无效。ROC分析显示，与单独使用美国国立卫生研究院卒中量表（NIHSS）评分相比，cSVD和NIHSS评分的组合对于任何ICH的曲线下面积更大（0.811，95%可信区间0.756-0.866 vs. 0.784，95%可信区间0.723-0.846，P = 0.0004）。
结论
cSVD总分与IVT后任何ICH的风险增加相关，并且与单独使用NIHSS相比，能改善对任何ICH的预测。
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