本文選題：缺血性腦卒中 + 出血轉(zhuǎn)化��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的通過對(duì)缺血性腦卒中患者發(fā)生出血轉(zhuǎn)化(Hemorrhagic transformation,HT)的相關(guān)危險(xiǎn)因素進(jìn)行統(tǒng)計(jì)學(xué)分析,建立同樣適用于非溶栓患者的預(yù)測(cè)模型,以期為臨床醫(yī)生在篩選HT高�；颊邥r(shí)提供一定的參考依據(jù)。方法篩選2015年1月-2016年9月青島大學(xué)附屬醫(yī)院神經(jīng)內(nèi)科收治的缺血性腦卒中患者,納入符合條件的327例,對(duì)患者的卒中病因、臨床表現(xiàn)、一般資料等進(jìn)行回顧分析。采用Logistic回歸分析等方法篩選出HT的危險(xiǎn)因素,建立新的預(yù)測(cè)模型,通過繪制受試者工作特征曲線(receiver operating characteristic curve,ROC)獲得評(píng)分界值,大于評(píng)分界值的為HT高危組,低于評(píng)分界值的為HT低危組。結(jié)果篩選符合條件的急性缺血性腦卒中患者,根據(jù)患者CT、MRI等影像學(xué)復(fù)查結(jié)果,分為出血轉(zhuǎn)化組(HT組)和非出血轉(zhuǎn)化組(NHT組)。與NHT組相比,HT組房顫病史、收縮壓、血糖、尿蛋白、白細(xì)胞數(shù)(WBC)、凝血酶原時(shí)間(PT-S)、國(guó)際標(biāo)準(zhǔn)化比值(INR)、溶栓治療、大面積梗死、美國(guó)國(guó)立衛(wèi)生研究院卒中量表(NIHSS)評(píng)分≥10分水平顯著偏高,血小板數(shù)、膽固醇、阿司匹林治療、氯吡格雷治療水平顯著偏低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。HT組與NHT組比較,入院TOAST分型差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)收縮壓組間進(jìn)行逐層比較,140-159mm Hg、160-179 mm Hg組間差異有統(tǒng)計(jì)學(xué)意義,余逐層比較無(wú)統(tǒng)計(jì)學(xué)差異。對(duì)血糖組間進(jìn)行逐層比較,7.0mmol/L、7.0-11.0mmol/L組間差異有統(tǒng)計(jì)學(xué)意義,余逐層比較無(wú)統(tǒng)計(jì)學(xué)差異。對(duì)收縮壓(160mm Hg,≥160mm Hg)、血糖(7.0mmol/L、≥7.0mmol/L)進(jìn)行再分組,帶入回歸分析。排除人為因素影響過大的阿司匹林、氯吡格雷治療因素,以及存在交叉的TAOST分型(與房顫病史)、PT-S(與INR)影響因素。Logistic回歸分析結(jié)果示:房顫病史(OR=4.94,95%CI:1.879~12.988,p=0.001)、收縮壓≥160mm Hg(OR=2.762,95%CI:1.175~6.494,p=0.02)、大面積腦梗死(OR=3.796,95%CI:1.495~9.635,p=0.05)、NIHSS評(píng)分≥10分(OR=5.665,95%CI:2.289~14.021,p0.05)、溶栓(OR=3.086,95%CI:4.981~96.257,p0.05)為HT的獨(dú)立危險(xiǎn)因素。根據(jù)Logistic回歸分析結(jié)果建立新的預(yù)測(cè)模型:Logit P=-3.588+1.579×X1+1.016×X2+1.334×X3+1.734×X4+3.086×X5。Logit P值越大,HT的風(fēng)險(xiǎn)越高,所建ROC曲線下的面積(AUC)為0.912(95%CI:0.873~0.950,P0.001),預(yù)測(cè)模型診斷價(jià)值較高。綜合判斷各點(diǎn)靈敏度加特異度之和,取youden指數(shù)(敏感度+特異度-1)最大時(shí)所對(duì)應(yīng)的最佳分界點(diǎn)為界值(cut-off值),界值為-2,此時(shí)靈敏度88.33%,特異度為82.02%。結(jié)論1.房顫病史、收縮壓≥160mm Hg、大面積腦梗死、NIHSS評(píng)分≥10分、溶栓治療為HT的獨(dú)立危險(xiǎn)因素。2.當(dāng)評(píng)分大于-2時(shí),HT的發(fā)生的風(fēng)險(xiǎn)顯著增高。
[Abstract]:Objective to establish a predictive model for non-thrombolytic patients by statistically analyzing the risk factors associated with hemorrhagic transformation in patients with ischemic stroke.In order to provide some reference for clinicians in screening HT high-risk patients.Methods from January 2015 to September 2016, 327 patients with ischemic stroke were selected from Department of Neurology, affiliated Hospital of Qingdao University. The etiology, clinical manifestation and general data of stroke were analyzed retrospectively.The risk factors of HT were screened by Logistic regression analysis, and a new prediction model was established. By drawing the operating characteristic curve of receiver operating characteristic curveveroc, the critical value of HT was obtained, and the high risk group of HT was found to be higher than the threshold of HT.The group with low risk of HT was lower than the score limit.Results the patients with acute ischemic stroke were selected and divided into two groups according to the imaging findings such as CT MRI. The patients were divided into two groups: Hemorrhage transformation group (HT group) and non-hemorrhagic conversion group (NHT group).Compared with NHT group, atrial fibrillation history, systolic blood pressure, blood glucose, urine protein, white blood cell count, prothrombin time (PT-SN), international standardized ratio (INRN), thrombolytic therapy, large area infarction were observed in HT group.NIH stroke scale score 鈮，

本文編號(hào)：1734137