急性脑梗死机械取栓后引流静脉早显与脑出血转化的关系  

Relationship between hemorrhagic transformation and angiographic early venous filling following mechanical thrombectomy for acute ischemic stroke

作　　者：刘振生[1] 孙勇[1] 匡雄伟[1] 周龙江[1] 唐铁钰 张文[3] Liu Zhensheng;Sun Yong;Kuang Xiongwei;Zhou Longjiang;Tang Tieyu;Zhang Wen(Department of Interventional Radiology,the Affiliated Hospital of Yangzhou University,Yangzhou 225001,China;Department of Neurology,the Affiliated Hospital of Yangzhou University,Yangzhou 225001,China;Department of Diagnostic Ultrasound,the Affiliated Hospital of Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属医院介入放射科,225001 [2]扬州大学附属医院神经科,225001 [3]扬州大学附属医院超声科,225001

出　　处：《中华放射学杂志》2020年第1期42-47,共6页Chinese Journal of Radiology

摘　　要：目的探讨急性脑梗死机械取栓术后血管造影显示引流静脉早显(EVF)与脑出血转化(HT)的关系。方法回顾性分析2015年1月至2018年11月,扬州大学附属医院经机械取栓的急性前循环大血管闭塞患者的影像及人口统计资料、血管危险因素及其他临床资料。参照欧洲协作急性卒中研究Ⅱ(ECASSⅡ),对机械取栓术后HT进行改良分型(HT阴性、HT-Ⅰ型和HT-Ⅱ型),并对其EVF发生率、基线特征及临床预后进行比较。应用多变量logistic回归分析HT和临床预后的独立危险因素。采用受试者操作特征曲线(ROC)分析EVF预测HT-Ⅱ型的效能。结果98例接受机械取栓患者纳入分析,其中HT阴性48例(49.0%,48/98)、HT-Ⅰ型40例(40.8%,40/98)、HT-Ⅱ型10例(10.2%,10/98)。3组患者的年龄及心房颤动、EVF、预后不良发生率的差异具有统计学意义(P<0.05)。多变量logistic回归分析显示EVF[优势比(OR)5.962,95%CI 1.750~8.964,P=0.001]和心房颤动(OR 3.485,95%CI 1.962~18.986,P=0.028)是发生HT-Ⅱ的独立危险因素;未发现HT-Ⅰ的独立危险因素;基线美国国立卫生研究院卒中量表(NIHSS)评分(OR 1.162,95%CI 1.021~1.345,P=0.038)、EVF(OR 5.358,95%CI 1.665~13.653,P=0.006)和HT-Ⅱ(OR 1.326,95%CI 1.226~2.038,P=0.032)是预后不良的独立危险因素。EVF预测HT-Ⅱ的灵敏度、特异度分别为80.0%、86.4%,ROC曲线下面积为0.832。结论急性脑梗死机械取栓后血管造影出现EVF预示再通后HT-Ⅱ型出血转化风险增加及预后不良。Objective To explore the relationship between cerebral hemorrhagic transformation(HT)and angiographic early venous filling(EVF)following mechanical thrombectomy for acute ischemic stroke.Methods A retrospective imaging analysis was performed in the consecutive patients treated from January 2015 to November 2018 for acute anterior circulation large vessel occlusion using mechanical thrombectomy on the Affiliated Hospital of Yangzhou University.The demography,vascular risk factors and other clinical data of the patients were also collected.According to the experimental study of European Cooperative Acute Stroke StudyⅡ(ECASSⅡ),the modified classification of HT after mechanical thrombectomy was divided into HT negative,HT-Ⅰtype and HT-Ⅱtype.The differences in EVF,clinical and demographic characteristics were compared.Multivariate logistic regression analysis was used to identify the independent risk factors for HT and clinical outcome.Diagnostic test characteristics of EVF for HT-Ⅱtype were determined using a receiver operating characteristic curve(ROC)analysis.Results A total of 98 patients with acute ischemic stroke who received mechanical thrombectomy were enrolled,including HT negative in 48 cases(49.0%,48/98),HT-Ⅰin 40 cases(40.8%,40/98)and HT-Ⅱin 10 cases(10.2%,10/98).Significant differences were noted in age,and incidence of atrial fibrillation,EVF and poor outcomes among three groups(P<0.05).Multivariate logistic regression analysis showed that EVF[odds ratio(OR)5.960,95%CI 1.750-8.960,P=0.001]and atrial fibrillation(OR 3.485,95%CI 1.962-18.986,P=0.028)were risk factors for the occurrence of HT-Ⅱafter mechanical thrombectomy.No risk factor for HT-Ⅰwas noted.Baseline National Institute of Health Stroke Scale(NIHSS)score(OR 1.162,95%CI 1.021-1.345,P=0.038),EVF(OR 5.358,95% CI 1.665-13.653,P=0.006)and HT-Ⅱ(OR 1.326,95%CI 1.226-2.038,P=0.032)were independent risk factors for poor outcomes.And the sensitivity and specificity of EVF in prediction for HT-Ⅱwere 80.0%and 86.4% respectively,with t

关 键 词：脑梗死 放射学 介入性 手术后并发症 危险因素 血栓切除术 

分 类 号：R74[医药卫生—神经病学与精神病学]