卒中患者预后指数对急性前循环大血管闭塞性卒中早期血管内治疗临床预后的评估  

Evaluation of stroke prognostication using age and National Institute of Health Stroke Scale index for outcome after early endovascular treatment for anterior circulation large vessel occlusion

作　　者：黄显军[1] 朱武生[2] 杨倩[1] 朱玉娟[1] 石小蕾 段振晖 葛良[1] 丁贤惠 许向军 周志明[1] Huang Xianjun;Zhu Wusheng;Yang Qian;Zhu Yujuan;Shi Xiaolei;Duan Zhenhui;Ge Liang;Ding Xianhui;Xu Xiangjun;Zhou Zhiming(Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)

机构地区：[1]皖南医学院弋矶山医院神经内科,安徽省芜湖市241001 [2]南京军区南京总医院神经内科

出　　处：《中华神经科杂志》2018年第9期705-711,共7页Chinese Journal of Neurology

基　　金：国家自然科学基金资助项目（81701061）

摘　　要：目的研究卒中患者预后指数（SPAN）对前循环急性大血管闭塞性卒中（ALVOS）患者早期血管内治疗临床预后的评估价值。方法序贯性收集2014年12月至2017年9月就诊于皖南医学院弋矶山医院和2014年3月至2017年3月就诊于南京军区南京总医院的前循环ALVOS患者并行早期血管内治疗。将入组患者的年龄和NIHSS评分总和定义为SPAN指数；根据患者的SPAN得分将其分为SPAN〈100和SPAN≥100两组，比较两组间患者的基线资料以及各项围手术参数。以90 d改良Rankin量表评分≤2分为预后良好，采用单因素分析和多因素Logistic回归分析探讨影响患者预后的独立危险因素。结果最终共入组190例患者，SPAN〈100组170例（89.5%），SPAN≥100组20例（10.5%）。两组患者在术后颅内出血转化、90 d病死率上差异均无统计学意义；但在90 d功能独立率上，SPAN〈100组（77/170，45.3%）明显高于SPAN≥100组（4/20，20.0%），差异具有统计学意义（χ2＝4.681，P＝0.030）。Logistic回归分析显示，术前高收缩压（OR＝1.030，95% CI 1.008～1.052，P＝0.007）、低Alberta卒中项目早期CT（ASPECT）评分（OR＝1.609，95% CI 1.056～2.453，P＝0.027）以及不良侧支循环（OR＝5.714，95% CI 1.668～19.570，P＝0.006）是影响患者预后的独立危险因素。结论SPAN指数并不能作为急性前循环大血管闭塞性卒中早期血管内治疗的风险预估工具。ObjectiveTo evaluate the value of stroke prognostication using age and National Institute of Health Stroke Scale index（SPAN） for outcome after early endovascular treatment for anterior circulation large vessel occlusion.MethodsThe patients who underwent early endovascular treatment were prospectively, sequentially collected in Yijishan Hospital of Wannan Medical College from December 2014 to September 2017 and Jinling Hospital from March 2014 to March 2017. Individuals whose age in years plus NIHSS score was greater than or equal to 100 were designated as SPAN-100-positive patients, while those with a score less than 100 were designated as SPAN-100-negative patients. We compared the baseline data and perioperative data between the two groups. The 90 days modified Rankin Scale score≤2 was regarded as favorable outcome. Single factor and multivariable Logistic regression analyses were used to determine the association between SPAN-100 and outcomes.ResultsOne hundred and ninety patients were enrolled, 20（10.5%） of which were SPAN-100 positive, and 170（89.5%） were SPAN-100 negative. There were no significant differences between the two groups on postoperative intracerebral hemorrhage and 90 days mortality. Ninety days independence rates were higher in SPAN-100-negative patients（77/170, 45.3%） than in SPAN-100 positive patients （4/20, 20.0%; χ2=4.681, P=0.030）. Multi-factor Logistic regression analysis showed that the higher preoperation systolic pressure （OR=1.030, 95% CI 1.008-1.052, P=0.007）, the lower Alberta Stroke Program Early CT Score （OR=1.609, 95% CI 1.056-2.453, P=0.027） and poor collateral circulation（OR=5.714, 95% CI 1.668-19.570, P=0.006） were the independent risk factors of outcomes.ConclusionSPAN-100 is not an independent predictor of favorable outcome after adjusting for factors of outcomes in patients with anterior circulation large vessel occlusion.

关 键 词：卒中 年龄 机械取栓 预后 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]