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目的比较5种评分系统对不同时间窗的急性脑梗死静脉溶栓后出血转化(hemorrhagic transformation,HT)风险的预测价值。方法对2014年1月至2016年12月对不同时间窗内仅接受重组组织型纤溶酶原激活物(recombinant tissue-type plasminogen activator,rt-PA)静脉溶栓的243例急性脑梗死患者进行单中心、回顾性研究。应用HAT评分、GRASPS评分、SEDAN评分、MSS评分及SITS评分量表进行测评,观察5种评分系统与不同时间窗内的急性脑梗死接受静脉溶栓后出现HT的关系;应用ROC曲线下面积大小比较5种评分系统在不同时间窗静脉溶栓后出HT的预测能力。结果针对不同时间窗,比较5种评分系统ROC曲线下面积,结果显示:≤3 h时GRASPS及HAT评分系统的ROC曲线下面积(分别为0.698、0.619)高于其他评分系统;>3~4.5 h时,SEDAN评分、HAT评分(ROC面积分别为0.744,0.719)优于其他评分系统(P<0.05);>4.5~6 h时,HAT评分系统(ROC曲线下面积为0.676)优于其他评分系统。结论 5种评分系统对所有时间窗静脉溶栓后HT的发生有较好的预测能力。在不同时间窗,特别是在4.5 h内,HAT评分系统对HT风险预测可能拥有相对较好的预测价值。
Objective To compare the predictive value of five scoring systems on the risk of hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute cerebral infarction at different time windows. Methods From January 2014 to December 2016, 243 patients with acute cerebral infarction received intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in different time windows Single center, retrospective study. HAT score, GRASPS score, SEDAN score, MSS score and SITS score scale were used to evaluate the relationship between the five scoring systems and HT in different time windows after intravenous thrombolysis. The area under the ROC curve Five different scoring systems were compared to predict the ability of HT after thrombolysis in different time windows. Results The areas under the ROC curve of the five scoring systems were compared for different time windows. The results showed that the area under the ROC curve of GRASPS and HAT scoring system (0.698 and 0.619 respectively) was higher than other scoring systems at ≤ 3 h; h, the SEDAN score and HAT score (ROC area were 0.744 and 0.719, respectively) were superior to those of other scoring systems (P <0.05). HART scoring system (area under ROC curve 0.676) system. Conclusions The five scoring systems have good predictive ability for the occurrence of HT after thrombolysis in all time windows. At different time windows, especially within 4.5 h, the HAT scoring system may have relatively good predictive value for HT risk prediction.