[1]岳蒙丽,夏元亮,锁六军,等.急性缺血性脑卒中静脉溶栓后出血转化结局的预测模型构建与内部验证[J].陕西医学杂志,2026,(9):1248-1252，1267.[doi:DOI:10.3969/j.issn.1000-7377.2026.09.016]
　YUE Mengli,XIA Yuanliang,SUO Liujun,et al.Developing and internally validating a nomogram to predict hemorrhage following IV thrombolysis in acute ischemic stroke[J].,2026,(9):1248-1252，1267.[doi:DOI:10.3969/j.issn.1000-7377.2026.09.016]
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急性缺血性脑卒中静脉溶栓后出血转化结局的预测模型构建与内部验证

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年9期
页码:
1248-1252，1267
栏目:
临床研究
出版日期:
2026-09-05

文章信息/Info

Title:
Developing and internally validating a nomogram to predict hemorrhage following IV thrombolysis in acute ischemic stroke
作者:
岳蒙丽1; 夏元亮1; 锁六军1; 葛腾云1; 陈磊2
（1.阜阳市肿瘤医院神经内科，安徽 阜阳 236000;2.广东医科大学附属东莞第一医院神经外科，广东 东莞 523000）
Author(s):
YUE Mengli1; XIA Yuanliang1; SUO Liujun1; GE Tengyun1; CHEN Lei2
（1.Department of Neurology,Fuyang Cancer Hospital,Fuyang 236000,China；2.Department of Neurosurgery,The First Dongguan Hospital Affiliated to Guangdong Medical University,Dongguan 523000,China）
关键词:
脑卒中; 列线图; 静脉溶栓; 出血; 内部验证
Keywords:
Apoplexy; Nomogram; Intravenous thrombolysis; Hemorrhage; Internal validation
分类号:
R 743
DOI:
DOI:10.3969/j.issn.1000-7377.2026.09.016
文献标志码:
A
摘要:
目的：筛选急性缺血性脑卒中（AIS）静脉溶栓后24 h内发生出血转化（HT）的影响因素，并以此构建及内部验证预测模型。方法：收集就诊的192例AIS患者临床资料，全部样本经分层随机分配，训练集与验证集分别纳入134例和58例，分配比例为7∶3。在训练集中，根据静脉溶栓后24 h内HT的发生情况，将其分为发生HT者16例与未发生HT者118例。经单因素及多因素Logistic回归筛选独立危险因素，建立列线图预测模型，并借助ROC曲线、校准曲线与Hosmer-Lemeshow检验评价模型性能。结果：HT组高血压比例、美国国立卫生研究院卒中量表（NIHSS）评分、发病至溶栓时间、心源性栓塞型占比、中性粒细胞计数、D-二聚体及总胆红素（TBIL）水平均高于非HT组（均P<0.05），尿酸及血钾水平更低（均P<0.05）。多因素回归显示：中性粒细胞计数、D-二聚体、TBIL升高为独立危险因素，尿酸、血钾升高为独立保护因素（均P<0.05）。所建模型训练集AUC为0.865，验证集AUC为0.815；校准曲线提示预测概率与实际发生率吻合度良好（P=0.197）。结论：中性粒细胞计数、D-二聚体、TBIL、尿酸及血钾是AIS静脉溶栓后HT的独立预测因素，所建列线图模型内部验证效能良好，可为临床HT风险评估提供参考。
Abstract:
Objective:To determine independent factors driving 24hour hemorrhage following IV thrombolysis in acute ischemic stroke,and establish an internally validated nomogram for early risk stratification.Methods:From February 2021 to August 2025,192 acute ischemic stroke patients treated with intravenous thrombolysis at our hospital were enrolled.They were split into a training cohort (n=134) and a validation cohort (n=58) by 7∶3 stratified randomization.In the training cohort,patients were subdivided into hemorrhage group (n=16) and nonhemorrhage group (n=118) based on 24hour postthrombolysis hemorrhage occurrence.Sequential univariate and multivariate logistic regression analyses were applied to identify independent predictive factors for postthrombolysis hemorrhage,and a nomogram was constructed.Model discrimination and calibration were evaluated using ROC curves,calibration plots,and the HosmerLemeshow test.Results:The hemorrhage group had higher rates of hypertension,cardiogenic embolism,elevated baseline NIHSS scores,and longer onsettothrombolysis time.Hemorrhage patients also showed significantly increased neutrophil count,D-dimer,and total bilirubin (TBIL),but decreased uric acid and serum potassium (all P<0.05).Multivariate analysis confirmed elevated neutrophil count,D-dimer,and TBIL as independent risk factors,while higher uric acid and serum potassium were independent protective factors (all P<0.05).The nomogram yielded an AUC of 0.865 in the training cohort and 0.815 in the validation cohort.Calibration analysis demonstrated good agreement between predicted and actual hemorrhage risk (HosmerLemeshow test,P=0.197).Conclusion:Neutrophil count,D-dimer,TBIL,uric acid,and serum potassium are reliable independent biomarkers for postthrombolysis hemorrhage prediction.The constructed nomogram has favorable discrimination and calibration in internal validation,facilitating individualized clinical risk stratification and early intervention.

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备注/Memo

备注/Memo:
广东省医学科学基金资助项目(A2023438)
更新日期/Last Update: 2026-09-15