目的：研究血栓负荷评分（clot burden score，CBS）和急性前循环大血管闭塞型卒中患者血管内治疗
术后出血转化（hemorrhagic transformation，HT）的关系。方法：回顾性收集2019年1月至2023年12月收
治的急性前循环大血管闭塞型卒中且接受血管内治疗的患者111例，根据术后是否发生HT将其分为HT
组（45例）和非HT组（66例）。比较2组基线资料并进行分析，使用二元Logistic回归分析CBS评分和HT
的关系。采用分析受试者工作特征（ROC）曲线评价预测价值。结果：与非HT组相比，HT组患者的入院
NIHSS评分、入院血糖、发病至股动脉穿刺时间更长，纤维蛋白原更低、CBS≤5分、术前静脉溶栓、术后脑
造影剂外渗，冠心病人数比例更高，差异有统计学意义（P≤0.1）。二元Logistic回归分析发现：CBS≤5分
（OR=5.04，95% CI 1.41～18.06，P=0.013）、入院NIHSS评分高（OR=1.07，95% CI 1.01～1.14，P=0.042），发
病至股动脉穿刺时间长（OR=1.01，95% CI 1.000～1.013，P=0.049）、CBS≤5 分（OR=5.04，95% CI 1.41～
18.06，P=0.013）、术后有造影剂外渗（OR=3.27，95% CI 1.23～8.71，P=0.018）是急性前循环大血管闭塞型
卒中患者血管内治疗术后发生HT的独立危险因素。ROC曲线发现：CBS评分预测HT的曲线下面积为
0.629；CBS评分联合入院NIHSS评分、发病至股动脉穿刺时间、术后脑造影剂外渗对预测HT的曲线下面
积为0.829。结论：CBS≤5分是急性前循环大血管闭塞型卒中患者血管内治疗术后HT的独立危险因素。
To investigate the correlation between clot burden score (CBS) and hemorrhagic
transformation (HT) after endovascular therapy in patients with acute anterior circulation large vessel occlusion
stroke. Methods: A total of 111 patients diagnosed with acute anterior circulation large vessel occlusion stroke
who received endovascular therapy between January 2019 and December 2023 were retrospectively enrolled.
Patients were divided into HT group (45 cases) and non-HT group (66 cases) according to the presence or
absence of postoperative HT. Baseline data of the two groups were compared and analyzed. Binary Logistic
regression analysis was applied to explore the association between CBS and HT, and receiver operating
characteristic (ROC) curve analysis was performed to assess the predictive value. Results: Compared with the
non-HT group, the HT group presented significantly higher admission NIHSS score, elevated admission blood
glucose, longer time from symptom onset to femoral artery puncture, lower fibrinogen level, higher proportions
of patients with CBS≤5, preoperative intravenous thrombolysis, postoperative cerebral contrast extravasation
and coronary heart disease, with statistically significant differences. Binary Logistic regression analysis
identified that CBS≤5 (OR=5.04, 95% CI 1.41～18.06, P=0.013), high admission NIHSS score (OR=1.07,
95%CI 1.01～1.14, P=0.042), prolonged time from onset to femoral artery puncture (OR=1.01, 95%CI 1.000～
1.013, P=0.049) and postoperative contrast extravasation (OR=3.27, 95% CI 1.23～8.71, P=0.018) were
independent risk factors for HT after endovascular therapy in patients with acute anterior circulation large
vessel occlusion stroke. ROC curve analysis revealed that the area under the curve (AUC) of CBS for
predicting HT was 0.629; the AUC of the combined model (CBS plus admission NIHSS score,
onset-to-puncture time and postoperative cerebral contrast extravasation) reached 0.829. Conclusion: CBS≤
5 is an independent risk factor for postoperative HT in patients with acute anterior circulation large vessel
occlusion stroke treated with endovascular therapy.
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