【摘要】：目的分析SPAN-100評(píng)分聯(lián)合高敏C-反應(yīng)蛋白(hs-CRP)預(yù)測(cè)缺血性腦卒中(AIS)靜脈溶栓(IVT)后癥狀性顱內(nèi)出血(sICH)風(fēng)險(xiǎn)的價(jià)值。方法連續(xù)納入2012年5月1日—2016年3月1日在湖北省中西醫(yī)結(jié)合醫(yī)院神經(jīng)內(nèi)科住院進(jìn)行IVT治療、并有完整臨床資料的AIS患者93例,AIS發(fā)病4.5 h內(nèi)應(yīng)用rt-PA進(jìn)行IVT治療,按溶栓后復(fù)查頭顱CT或MR和NIHSS評(píng)分變化分為sICH組(8例)和非non-sICH組(85例)。分析2組SPAN-100評(píng)分、hs-CRP及其相關(guān)腦血管病危險(xiǎn)因素的差異,并進(jìn)一步分析影響sICH發(fā)生的獨(dú)立預(yù)測(cè)因素。采用受試者工作特征(ROC)曲線分析計(jì)算曲線下面積(AUC)及95%CI評(píng)價(jià)SPAN-100評(píng)分、hs-CRP和兩者聯(lián)合預(yù)測(cè)sICH發(fā)生的價(jià)值。結(jié)果 2組基線資料分析表明,sICH組年齡、溶栓前NIHSS評(píng)分、溶栓前收縮壓、hs-CRP水平和SPAN-100評(píng)分陽性明顯高于non-sICH組(t=2.766、3.679、3.613、2.305,χ~2=19.079,P均0.05)。單因素分析表明,年齡、溶栓前NIHSS評(píng)分、溶栓前收縮壓、hs-CRP水平和SPAN-100評(píng)分與sICH均呈正相關(guān)關(guān)系(r=0.278、0.360、0.248、0.235、0.453,P均0.05)。多因素Logistic回歸分析表明,年齡大(OR=1.171,95%CI 1.018~1.346)、hs-CRP水平升高(OR=1.258,95%CI 1.032~1.533)、SPAN-100評(píng)分陽性(OR=9.729,95%CI 1.386~68.277)是發(fā)生sICH的獨(dú)立預(yù)測(cè)因素。ROC曲線分析表明,SPAN-100評(píng)分AUC=0.726(95%CI 0.503~0.950)、hs-CRP水平AUC=0.711(95%CI0.501~0.921)和兩者聯(lián)合AUC=0.768(95%CI 0.548~0.989),差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 SPAN-100評(píng)分是一種簡(jiǎn)單、易計(jì)算、有效的預(yù)測(cè)sICH的工具,與hs-CRP聯(lián)合檢測(cè)可明顯提高預(yù)測(cè)IVT后sICH的價(jià)值。
[Abstract]:Objective to analyze the value of SPAN-100 score combined with Gao Min C-reactive protein (hs-CRP) in predicting (sICH) risk of symptomatic intracranial hemorrhage after (AIS) intravenous thrombolytic (IVT) in ischemic stroke. Methods from May 1, 2012 to March 1, 2016, 93 patients with IVT were admitted to the Department of Neurology, Integrated traditional Chinese and Western Medicine Hospital of Hubei Province, and had complete clinical data. Rt-PA was used for IVT treatment within 4.5 hours after the onset of AIS. According to the changes of CT or MR and NIHSS scores after thrombolysis, the patients were divided into sICH group (8 cases) and non non-sICH group (85 cases). To analyze the difference of SPAN-100 score, hs-CRP and related cerebrovascular risk factors between the two groups, and to further analyze the independent predictive factors that affect the occurrence of sICH. The area under the curve (AUC) and 95%CI were calculated by using the (ROC) curve of the subjects' operating characteristics to evaluate the SPAN-100 score. The value of hs-CRP and the combination of hs-CRP and both were used to predict the occurrence of sICH. Results the baseline data analysis showed that the age, NIHSS score, systolic blood pressure, hs-CRP level and SPAN-100 score in sICH group were significantly higher than those in non-sICH group (t = 2.766 ~ 3.679 / 3.6132.305, 蠂 ~ 219.079P < 0.05). Univariate analysis showed that age, NIHSS score before thrombolytic therapy, systolic blood pressure before thrombolysis, hs-CRP level and SPAN-100 score were positively correlated with sICH (r = 0.2780.360 / 0.248U 0.2350.453n, all P 0.05). Multivariate Logistic regression analysis showed that age (OR=1.171,95%CI 1.018 鹵1.346) and hs-CRP level increased (OR=1.258,95%CI 1.032 鹵1.533). The positive SPAN-100 score (OR=9.729,95%CI 1.386 + 68.277) was an independent predictor of sICH. ROC curve analysis showed that SPAN-100 score AUC=0.726 (95%CI 0.503 鹵0.950). Hs-CRP level AUC=0.711 (95%CI0.501~0.921) and combined AUC=0.768 (95%CI 0.548 鹵0.989) were significantly different (P0.05). Conclusion SPAN-100 score is a simple, easy to calculate and effective tool for predicting sICH. Combined detection with hs-CRP can significantly improve the value of predicting sICH after IVT.
【作者單位】： 湖北省中西醫(yī)結(jié)合醫(yī)院神經(jīng)內(nèi)科;
【分類號(hào)】：R743.3

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