风险模型预测急性前循环缺血性卒中机械取栓后脑出血及不良结局的比较

发布时间：2018-04-27 16:05

  本文选题：卒中 + 机械取栓　； 参考：《中国脑血管病杂志》2017年04期

【摘要】：目的比较血管事件总体健康风险(THRIVE),多中心卒中调查(MSS),休斯敦动脉内治疗(HIAT)及葡萄糖水平、种族、年龄、性别、收缩压水平、卒中程度(GRASPS)评分4种风险模型预测急性前循环缺血性卒中机械取栓后脑出血与不良结局的效能。方法前瞻性连续性纳入2013年5月至2016年3月收住南京大学附属金陵医院和厦门大学附属中山医院神经内科发病6 h内的急性前循环大血管闭塞并实施机械取栓的患者153例。采用Logistic回归分析和受试者工作特征(ROC)曲线下面积(AUC)探讨THRIVE、MSS、HIAT、GRASPS评分4种风险模型预测急性前循环缺血性卒中机械取栓后,脑出血与不良结局[包括90 d全因死亡和90 d改良Rankin量表(mRS)评分≥3分]的效能。结果 MSS评分(AUC为0.639,95%CI:0.548~0.730,P=0.004)和GRASPS评分(AUC为0.616,95%CI:0.525~0.706,P=0.017)能够预测脑出血事件,但预测准确性较低;4种模型对机械取栓后90 d内死亡均有预测价值,其中GRASPS评分(AUC为0.783,95%CI:0.706~0.860,P0.001)有中等预测准确性,其余3种模型AUC0.7,预测准确性低;4种模型均能对90d不良预后(90 dmRS≥3分)进行预测,其中GRASPS评分及THRIVE评分AUC均0.7,GRASPS评分AUC最大(AUC为0.782,95%CI:0.708~0.855,P0.01),两者有中度预测准确性。结论 GRASPS评分对机械取栓后90 d内全因死亡及不良预后均有较好的临床预测价值,THRIVE评分对90 d不良预后有较好的临床预测价值。4种模型对机械取栓后脑出血事件的预测价值仍有待验证。
[Abstract]:Objective to compare the overall health risk of vascular events (THRIVE), multiple center stroke survey (MSSU), intra-arterial therapy (HI) in Houston and glucose levels, race, age, sex, systolic blood pressure (SBP). Efficacy of four risk models for predicting cerebral hemorrhage and adverse outcome after mechanical thrombectomy in patients with acute anterior circulation ischemic stroke. Methods from May 2013 to March 2016, 153 patients with acute anterior circulation macrovascular occlusion and mechanical thrombectomy were enrolled in the neurology department of Jinling Hospital affiliated to Nanjing University and Zhongshan Hospital affiliated to Xiamen University from May 2013 to March 2016. Using the Logistic regression analysis and the area under the operating characteristic curve of subjects, four risk models of THRIVE and MSSHIATATGRASPS score were used to predict the risk of mechanical thrombus removal after acute anterior circulatory ischemic stroke. Efficacy of intracerebral hemorrhage and adverse outcome [including 90 days of all-cause death and 90 days of modified Rankin scale with mRSs 鈮，

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