作者：许鑫格，孙林林，武百强，王甜甜，李志营

单位：

1.新乡医学院2.河南省郑州市第七人民医院神经外科3.河南省郑州市第七人民医院康复科4.河南省郑州市第七人民医院神经内科5.河南省郑州市第七人民医院医务科

Units：

1.XinxiangMedicalUniversity,Xinxiang453000,China2.DepartmentofNeurosurgery,the7thPeople'sHospitalofZhengzhou,Zhengzhou450016,China3.DepartmentofRehabilitation,the7thPeople'sHospitalofZhengzhou,Zhengzhou450016,China4.DepartmentofNeurology,the7thPeople'sHospitalofZhengzhou,Zhengzhou450016,China5.MedicalSection,the7thPeople'sHospitalofZhengzhou,Zhengzhou450016,China

关键词：

缺血性卒中; 钾; 溶栓; 出血转化; 预后;

Keywords：

Ischemicstroke;Potassium;Thrombolysis;Hemorrhagetransformation;Prognosis

CLC：

R743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.075

Funds：

2021年度河南省医学科技攻关计划联合共建项目( LHGJ20210755?)

摘要：

目的 探究溶栓前血钾与急性缺血性卒中（AIS）患者溶栓后出血转化（HT）及短期预后的关系。方法选取2020年1月至2022年6月在郑州市第七人民医院急诊卒中绿色通道接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓的AIS患者243例。所有患者接受阿替普酶静脉溶栓治疗，将发生HT的患者作为HT组（n=38），其余患者作为非HT组（n=205）。比较两组一般资料、溶栓前实验室检查指标、预后指标。采用多因素Logistic回归分析探讨AIS患者溶栓后发生HT的影响因素。绘制ROC曲线以评估相关指标对AIS患者溶栓后发生HT的预测价值。采用Spearman秩相关分析探讨血钾与AIS患者美国国立卫生研究院卒中量表（NIHSS）评分差值、治疗14 d后改良Rankin量表（mRS）评分的相关性。结果 HT组有心房颤动史者占比、溶栓前NIHSS评分、溶栓前纤维蛋白原、mRS评分高于非HT组，溶栓前血钾、血钙及NIHSS评分差值低于非HT组（P<0.05）。多因素Logistic回归分析结果显示，溶栓前NIHSS评分升高是AIS患者溶栓后发生HT的独立危险因素，溶栓前血钾升高是AIS患者溶栓后发生HT的独立保护因素（P<0.05）。ROC曲线分析结果显示，溶栓前NIHSS评分、血钾预测AIS患者溶栓后发生HT的AUC分别为0.718[95%CI(0.624,0.811)]、0.764[95%CI(0.702,0.826)]，最佳截断值分别为17.5分、3.8 mmol/L，灵敏度分别为78.0%、62.0%，特异度分别为57.9%、94.7%。AIS患者溶栓前血钾与NHISS评分差值呈正相关（rs=0.188,P=0.003），与治疗14 d后mRS评分呈负相关（rs=-0.175,P=0.006）。结论 溶栓前血钾升高是AIS患者溶栓后发生HT的独立保护因素，溶栓前血钾对AIS患者溶栓后发生HT有一定预测价值，且溶栓前血钾<3.8 mmol/L与AIS患者溶栓后短期预后不良有关。

Abstract：

ObjectiveToexploretherelationshipbetweenserumpotassiumbeforethrombolysisandhemorrhagetransformation(HT)afterthrombolysisandshort-termprognosisinpatientswithacuteischemicstroke(AIS).MethodsAtotalof243AISpatientswhoreceivedintravenousthrombolysistherapywithrecombinanttissueplasminogenactivator(rt-PA)intheGreenChannelofEmergencyStrokeinthe7thPeople'sHospitalofZhengzhoufromJanuary2020toJune2022wereselected.Allpatientsreceivedintravenousthrombolytictherapywithalteplase.PatientswithHTwereincludedintheHTgroup(n=38)andtherestwereincludedinthenon-HTgroup(n=205).Generaldata,laboratoryindicatorsandprognosticindexeswerecomparedbetweenthetwogroups.MultivariateLogisticregressionanalysiswasusedtoinvestigatetheinfluencingfactorsofHTafterthrombolysisinAISpatients.ROCcurvewasdrawntoevaluatethepredictivevalueofrelevantindicatorsforHTafterthrombolysisinAISpatients.SpearmanrankcorrelationanalysiswasusedtoinvestigatethecorrelationbetweenbloodpotassiumandNationalInstitutesofHealthStrokeScale(NIHSS)scoredifferenceandmodifiedRankinScale(mRS)scoreafter14dofthrombolysis. ResultsProportianofpatientswithhistoryofatrialfibrillation,pre-thrombolysisNIHSSscore,pre-thrombolysisfibrinogenandmRSscoreinHTgroupwerehigherthanthoseinnon-HTgroup,pre-thrombolysisserumpotassium,pre-thrombolysiscalciumandNIHSSscoredifferencewerelowerthanthoseinnon-HTgroup(P<0.05).MultivariateLogisticregressionanalysisshowedthatincreasedNIHSSscorebeforethrombolysiswasanindependentriskfactorforHTafterthrombolysisinAISpatients,andincreasedbloodpotassiumbeforethrombolysiswasanindependentprotectivefactorforHTafterthrombolysisinAISpatients(P<0.05).ROCcurveanalysisresultsshowedthattheAUCofpre-thrombolysisNIHSSscoreandpre-thrombolysisbloodpotassiuminpredictingHTafterthrombolysisinAISpatientswas0.718[95%CI(0.624,0.811)]and0.764[95%CI(0.702,0.826)],theoptimalcut-offvaluewas17.5pointsand3.8mmol/L,thesensitivitywas78.0%and62.0%,andthespecificitywas57.9%and94.7%,respectively.SerumpotassiumbeforethrombolysiswaspositivelycorrelatedwithNHISSscoredifference(rs=0.188,P=0.003),andnegativelycorrelatedwithmRSscore14daysaftertreatment(rs=-0.175,P=0.006).ConclusionIncreasedserumpotassiumbeforethrombolysisisanindependentprotectivefactorforHTafterthrombolysisinAISpatients.SerumpotassiumbeforethrombolysishasacertainpredictivevalueforHTafterthrombolysisinAISpatients,andpre-thrombolysisserumpotassium<3.8mmol/Lisassociatedwithpoorshort-prognosisafterthrombolysisinAISpatients.

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