目的:系统评价急性缺血性脑卒中(AIS)患者静脉溶栓后出血转化(HT)的风险预测模型。
方法:WebofScience,科克伦图书馆,PubMed,Embase,CINAHL,CNKI,CBM,万方,和VIP从开始至2023年2月25日检索与AIS溶栓后HT风险预测模型相关的文献.
结果:总共17项纳入的研究包含26个预测模型,所有模型在建模时的AUC范围为0.662至0.9854,16个模型的AUC>0.8,表明模型具有良好的预测性能。然而,大多数纳入研究存在偏倚风险.Meta分析结果显示房颤(OR=2.72,95%CI:1.98~3.73),NIHSS评分(OR=1.09,95%CI:1.07-1.11),葡萄糖(OR=1.12,95%CI:1.06-1.18),中度至重度脑白质疏松(OR=3.47,95%CI:1.61-7.52),大脑中动脉高密度征(OR=2.35,95%CI:1.10-4.98),大面积脑梗死(OR=7.57,95%CI:2.09-27.43),早期梗死征象(OR=4.80,95%CI:1.74~13.25)是AIS患者静脉溶栓后HT的有效预测因子。
结论:在中国人群中,AIS患者溶栓后HT的模型表现良好,但是有一些偏见的风险。未来中国人群AIS患者静脉内HT转化预测模型应关注房颤等预测因子,NIHSS得分,葡萄糖,中度至重度脑白质疏松症,大脑中动脉高密度征,大面积脑梗塞,和梗塞的早期迹象。
To systematically
review the risk prediction model of Hemorrhages Transformation (HT) after intravenous thrombolysis in patients with Acute Ischemic Stroke (AIS).
Web of Science, The Cochrane Library, PubMed, Embase, CINAHL, CNKI, CBM, WanFang, and VIP were searched from inception to February 25, 2023 for literature related to the risk prediction model for HT after thrombolysis in AIS.
A total of 17 included studies contained 26 prediction models, and the AUC of all models at the time of modeling ranged from 0.662 to 0.9854, 16 models had AUC>0.8, indicating that the models had good predictive performance. However, most of the included studies were at risk of bias. the results of the Meta-analysis showed that atrial fibrillation (OR=2.72, 95% CI:1.98-3.73), NIHSS score (OR=1.09, 95% CI:1.07-1.11), glucose (OR=1.12, 95% CI:1.06-1.18), moderate to severe leukoaraiosis (OR=3.47, 95% CI:1.61-7.52), hyperdense middle cerebral artery sign (OR=2.35, 95% CI:1.10-4.98), large cerebral infarction (OR=7.57, 95% CI:2.09-27.43), and early signs of infarction (OR=4.80, 95% CI:1.74-13.25) were effective predictors of HT after intravenous thrombolysis in patients with AIS.
The performance of the models for HT after thrombolysis in patients with AIS in the Chinese population is good, but there is some risk of bias. Future post-intravenous HT conversion prediction models for AIS patients in the Chinese population should focus on predictors such as atrial fibrillation, NIHSS score, glucose, moderate to severe leukoaraiosis, hyperdense middle cerebral artery sign, massive cerebral infarction, and early signs of infarction.