急性椎基底动脉闭塞性卒中患者血管内机械血栓切除术后死亡的预测因素  

Predictors of death after endovascular mechanical thrombectomy in patients with acute vertebrobasilar occlusive stroke

作　　者：刘文华 段振晖 郭章宝[1] 唐坤[1] 万小林 倪厚杰[1] 朱明辉 Liu Wenhua;Duan Zhenhui;Guo Zhangbao;Tang Kun;Wan Xiaolin;Ni Houjie;Zhu Minghui(Department of Neurology,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院神经内科,430022

出　　处：《国际脑血管病杂志》2019年第9期656-661,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨急性椎基底动脉闭塞性卒中(vertebrobasilar occlusive stroke,VBOS)患者血管内机械血栓切除术(endovascular mechanical thrombectomy,EMT)后死亡的预测因素。方法回顾性纳入在武汉市第一医院接受EMT治疗的急性VBOS患者,收集人口统计学和临床资料。根据术后90 d是否死亡,将患者分为生存组和死亡组,对两组人口统计学和临床资料比较,应用多变量logistic回归分析确定EMT术后90 d死亡的独立危险因素。结果共纳入47例患者,中位年龄62岁,男性34例(72.3%),中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分16分,42例(89.4%)血管再通(改良脑梗死溶栓血流分级2b/3级),12例(25.5%)在术后90 d内死亡。单变量分析显示,死亡组基线NIHSS评分[26(21~28)分对12(5~23)分;Z=-3.165,P=0.002]、中性粒细胞百分比(81.61%±11.82%对72.20%±12.09%;t=-2.137,P=0.033)、中性粒细胞/淋巴细胞比值(10.54±7.17对4.98±3.57;t=-2.393,P=0.017)以及SICH发生率(25.0%对2.9%;χ^2=5.627,P=0.018)显著高于生存组,而淋巴细胞百分比(12.00%±9.04%对20.67%±10.39%;t=-2.429,P=0.015)显著低于生存组。多变量logistic回归分析显示,高基线NIHSS评分[优势比(odds ratio,OR)1.243,95%可信区间(confidence interval,CI)1.046~1.318;P=0.038]、高中性粒细胞/淋巴细胞比值(OR 1.278,95%CI 1.002~1.630;P=0.049)以及发生有症状颅内出血(OR 5.088,95%CI 1.065~38.718;P=0.046)为死亡的独立预测因素。结论高基线NIHSS评分、高中性粒细胞/淋巴细胞比值以及发生有症状颅内出血是急性VBOS患者EMT术后90 d内死亡的独立预测因素。Objective To investigate the predictors of death after endovascular mechanical thrombectomy(EMT)in patients with acute vertebrobasilar occlusive stroke(VBOS).Methods Patients with acute VBOS treated with EMT in Wuhan No.1 Hospital were enrolled retrospectively.The demographic and clinical data were collected.According to whether the patients died at 90 d after procedure,they were divided into survival group and death group.The demographic and clinical data were compared between the two groups.Multivariate logistic regression analysis was used to determine the independent risk factors for death at 90 d after EMT.Results A total of 47 patients were enrolled.The median age was 62 years,34 were males(72.3%),the median baseline National Institutes of Health Stroke Scale(NIHSS)score was 16,42 patients(89.4%)had recanalization(modified Thrombolysis in Cerebral Infarction[mTICI]2b/3 grade),and 12(25.5%)died within 90 d after procedure.Univariate analysis showed that the baseline NIHSS score(26[21-28]vs.12[5-23];Z=-3.165,P=0.002),percentage of neutrophil(81.61%±11.82%vs.72.20%±12.09%;t=-2.137,P=0.033),neutrophil/lymphocyte ratio(10.54±7.17 vs.4.98±3.57;t=-2.393,P=0.017),and incidence of sICH(25.0%vs.2.9%;χ^2=5.627,P=0.018)in the death group were significantly higher than those in the survival group,while the percentage of lymphocyte(12.00%±9.04%vs.20.67%±10.39%;t=-2.429,P=0.015)was significantly lower than that of the survival group.Multivariate logistic regression analysis showed that high baseline NIHSS score(odds ratio[OR]1.243,95%confidence interval[CI]1.046-1.318;P=0.038),high neutrophil/lymphocyte ratio(OR 1.278,95%CI 1.002-1.630;P=0.049)and symptomatic intracranial hemorrhage(OR 5.088,95%CI 1.065-38.718;P=0.046)were the independent predictors for death.Conclusion High baseline NIHSS score,high neutrophil/lymphocyte ratio and symptomatic intracranial hemorrhage are the independent predictors for death within 90 d after EMT in patients with acute VBOS.

关 键 词：卒中 脑缺血 椎底动脉供血不足 血栓切除术 血管内手术 治疗结果 危险因素 

分 类 号：R73[医药卫生—肿瘤]