急性缺血性脑卒中静脉溶栓预后的多因素联合预测模型研究

目的:探讨通过建立多因素联合预测模型的方法预测急性缺血性脑卒中(AIS)患者使用阿替普酶静脉溶栓治疗后的远期临床预后.方法:通过使用回顾性研究的方法,分析118例接受阿替普酶静脉溶栓治疗的AIS患者的临床资料;通过溶栓后90 d的改良Rankin量表(mRS)分为预后良好组(mRS评分0～2分)和预后不良组(mRS评分...

Study on Multi-Factor Joint Predictive Model of Intravenous Thrombolytic Prognosis inAcute Ischemic Stroke

To investigate the long-term prognosis of patients with acute ischemic stroke (AIS) afterintravenous thrombolysis with alteplase by establishing a multi-factor combined prediction model. Methods: Aretrospective study was conducted to analyze 118 AIS patients treated with intravenous thrombolysis with alteplase. According to the modified Rankin scale (mRS) 90 days after thrombolysis, patients were divided intothe good prognosis group (mRS score 0-2 points) and poor prognosis group (mRS score 3-6 points). MultivariateLogistic regression was used to analyze the factors affecting the 90-day prognosis of neurological function inAIS patients after thrombolysis with alteplase and to determine the joint predictive value Y. The ROC curve wasused to verify the diagnostic validity of the Logistic regression model. Results: Among the 118 AIS patients,the prognosis was good in 56 patients (47.46%) and poor in 62 patients (52.54%). Compared to the good prognosis group, the poor prognosis group showed increased density of the middle cerebral artery sign and a higherbaseline NIHSS score, a lower ASPECT score, and a greater bleeding rate following thrombolysis (all P<0.05).Multivariate Logistic regression analysis showed that ASPECTS score and baseline NIHSS score affected thelong-term prognosis of intravenous thrombolysis (P<0.001), and the area under the ROC curve of the joint predictive value Y calculated by multi-factor Logistic regression was 0.740, with a sensitivity of 60.70% and a specificity of 74.19%. This was superior to using ASPECTS score (AUC=0.672, sensitivity =82.10%, specificity =48.39% ) and baseline NIHSS score (AUC=0.693, sensitivity =75.00% , specificity =59.68% ) alone to predictprognosis after AIS thrombolysis. Conclusion: The hyperdense middle cerebral artery sign, ASPECTS score,and baseline NIHSS score of AIS patients before thrombolysis can all be used as 90-day prognostic factors. Thejoint variable Y calculated by multi-factor Logistic regression can better predict prognosis.