急性椎基底动脉闭塞血管内治疗的临床预后分析  

Clinical prognoses of acute vertebral basilar artery occlusion by endovascular treatment

作　　者：刘金朝 李红伟[1] 陈付文 史宏生 王瞻 顾建军 王子亮 Liu Jinchao;Li Hongwei;Chen Fuwen;Shi Hongsheng;Wang Zhan;Gu Jianjun;Wang Ziliang(Department of Intervention,Puyang Oilfield General Hospital,Puyang 457000,China;Cerebrovascular Center,He'nan People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]濮阳市油田总医院介入科,457000 [2]郑州大学人民医院,河南省人民医院脑血管病中心,郑州450000

出　　处：《中华神经医学杂志》2019年第7期705-709,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨急性椎基底动脉闭塞血管内治疗的临床预后以及预后不良的危险因素。方法回顾性收集濮阳市油田总医院介入科自2016年8月至2017年12月行血管内治疗的43例急性椎基底动脉闭塞患者的临床资料,分析患者术后即刻血管再通率及3个月的临床预后,并依据预后结果分为预后良好组和预后不良组,采用受试者工作特征(ROC)曲线评价术前美国国立卫生研究院卒中量表(NIHSS)评分、发病至血管再通时间、改良的基于弥散加权成像的后循环的Alberta卒中项目早期CT评分(DWI-PC-ASPECTS)和基于磁共振血管成像(MRA)评估的基底动脉闭塞预后评分(MRA-BATMAN)对预后不良的预测效能,进一步采用单因素Logistic回归分析及多因素Logistic回归分析评估术前NIHSS评分、发病至血管再通时间、DWI-PC-ASPECTS评分、MRA-BATMAN评分与预后不良的关系。结果43例(100%)患者术后即刻均达到脑梗死溶栓分级(TICI)3/2b级;术后3个月后改良Rankin量表(mRS)评分0~2分患者26例(60.5%)(预后良好组),mRS评分3~6分患者17例(39.5%)(预后不良组)。ROC曲线分析显示,术前NIHSS评分为21分、发病至血管再通时间为600min、DWI-PC-ASPECTS评分为8.5分及MRA-BATMAN评分为6.5分时,预测预后不良的准确性最高(敏感度分别为0.941、0.706、0.808、0.577,特异度分别为0.846、0.423、0.647、0.824)。单因素Logistic回归分析显示,术前NIHSS评分≥21分、改良DWI-PC-ASPECTS评分≤8.5分、MRA-BATMAN评分≤6.5分是预后不良的危险因素(P<0.05)。多因素Logistic回归分析显示,术前NIHSS评分≥21分是预后不良的独立危险因素(OR=15.679,95%CI:1.608~152.879,P=0.000)。结论急性椎基底动脉闭塞血管内治疗安全有效,术前NIHSS评分≥21分患者预后不良的可能性高。Objective To investigate the clinical prognoses of acute vertebral basilar artery occlusion by endovascular treatment and the risk factors for poor prognosis. Methods Clinical data of 43 patients with acute vertebral basilar artery occlusion who underwent endovascular treatment in our hospital from August 2016 to December 2017 were retrospectively analyzed. The immediate revascularization rate and clinical outcomes three months after surgery were analyzed;and according to the clinical prognoses, these patients were divided into a good prognosis group and a poor prognosis group. Receiver operating characteristic (ROC) curve was used to compare the NIHSS scores, times from onset to vessel recanalization, improved post-circulation CT scale of Alberta stroke project based on diffusion weighted imaging (DWI-PC-ASPECTS) scores, and MR angiography-basilar artery on computed tomography angiography prognostic scalere for basilar artery occlusion (MRA-BATMAN) scores to predict the prognoses. Univariate Logistic regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of times from onset to vessel recanalization, NIHSS scores, DWI-PC-ASPECTS scores, and MRA-BATMAN scores with poor prognosis. Results Forty-three patients (100%) achieved thrombolysis in cerebral infarction (TICI) grading 3/2b immediately after surgery. The mRS scores were 0-2 in 26 patients (60.5%, good prognosis group), and those were 3-6 in 17 patients (39.5%, poor prognosis group) three months after surgery. When the NIHSS scores was 21, times from onset to vessel recanalization was 600 min, DWI-PC-ASPECTS predictive threshold was 8.5 and MRA-BATMAN predictive threshold was 6.5, the diagnostic accuracy of predicting poor prognosis was the highest (sensitivity=0.941, 0.706, 0.808, and 0.577, and specificity=0.846, 0.423, 0.647, and 0.824). Univariate Logistic regression analysis showed that preoperative NIHSS scores≥21, improved DWI-PC-ASPECTS scores≤8.5, and MRA-BATMAN scores≤6.5 were risk factors for poor

关 键 词：椎基底动脉 大血管闭塞 血管内治疗 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]