摘要： 目的 探讨溶栓后出血评分（HAT）、症状性溶栓出血危险因素评分（SEDAN）和相关危险因素预测急性缺血性卒中患者重组组织型纤溶酶原激活物（rt-PA）静脉溶栓后出血性转化的临床应用价值。方法 共143 例发病4.50 h 内行rt-PA 静脉溶栓且临床资料完整的急性缺血性卒中患者，根据溶栓治疗后头部CT 所示分为出血性转化组（18 例）和非出血性转化组（125 例），二分类Logistic回归分析筛选静脉溶栓后发生出血性转化的危险因素、受试者工作特征（ROC）曲线评价HAT 和SEDAN 评分预测出血性转化的敏感性和特异性。结果 单因素Logistic 回归分析显示，心房颤动、入院时收缩压和血糖水平、发病早期CT 呈低密度征象、溶栓时间窗、美国国立卫生研究院卒中量表（NIHSS）评分、HAT 和SEDAN 评分均为静脉溶栓后出血性转化危险因素（P < 0.05）；代入二分类Logistic 回归方程后，除发病早期CT 呈低密度征象，其余各项均为静脉溶栓后发生出血性转化之危险因素。ROC 曲线显示，HAT 评分预测出血性转化灵敏度为94.40%、特异度为41.60%、曲线下面积0.70，SEDAN 评分则为94.40%、65.62%和0.77。结论 心房颤动、入院时收缩压和血糖水平、溶栓时间窗、NIHSS 评分、HAT 和SEDAN 评分均为缺血性卒中静脉溶栓后发生出血性转化的危险因素，但以SEDAN 评分预测价值较高。

关键词: 脑缺血, 组织型纤溶酶原激活物, 脑出血, 危险因素

Abstract: Objective  To investigate the value of HAT and SEDAN score scales in predicting hemorrhagic transformation (HT) following the recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis in acute ischemic stroke patients and risk factors affecting HT.  Methods  A total of 143 patients with acute ischemic stroke underwent rt-PA intravenous thrombolysis within 4.50 h of onset and their clinical data were collected. According to head CT after thrombolysis, patients were divided into HT group (18 cases) and non-HT group (125 cases). Single factor analysis was used to assess differences in HAT and SEDAN score scales and related risk factors of ischemic stroke in 2 groups, and further Logistic regression analysis was used to investigate independent predictors of HT. Receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of HAT and SEDAN score scales in predicting HT.  Results  Univariate Logistic regression analysis showed that history of atrial fibrillation (AF), admission systolic blood pressure (SBP), admission blood glucose level, early low density of head CT, thrombolytic time window, National Institute of Health Stroke Scale (NIHSS), HAT and SEDAN scores were all risk factors for HT after thrombolysis (P < 0.05, for all). Multivariate Logistic regression analysis showed that history of AF (OR = 1.677, 95% CI: 1.332-2.111; P = 0.000), admission SBP (OR = 1.102, 95% CI: 1.009-1.204; P = 0.031), admission blood glucose level (OR = 1.870, 95% CI: 1.119-3.125; P = 0.017), thrombolysis time window (OR = 1.030, 95%CI: 1.009-1.052; P = 0.005), NIHSS score (OR = 1.574, 95%CI: 1.186-2.090; P = 0.002), HAT score (OR = 2.515, 95%CI: 1.273-4.970;P = 0.008) and SEDAN score (OR = 2.413, 95%CI: 1.123-5.185; P = 0.024) were risk factors for HT after thrombolysis. ROC curve analysis showed that HAT score could predict HT with 94.40% sensitivity and 41.60% specificity, and area under curve (AUC) was 0.70. SEDAN score could predict HT with 94.40% sensitivity and 65.62% specificity, and AUC was 0.77. Conclusions  History of AF, admission SBP, admission blood glucose level, thrombolysis time window, NIHSS, HAT and SEDAN score scales were independent risk factors for hemorrhagic transformation after intravenous thrombolysis for treating ischemic stroke, while SEDAN score had high predictive value.

Key words: Brain ischemia, Tissue plasminogen activator, Cerebral hemorrhage, Risk factors