探讨急性大面积脑梗死机械血栓切除术后预后的影响因素  

To explore the risk factors of outcome after mechanical thrombectomy in acute large area infarction

作　　者：靳明旭[1] 李璐 彭明洋 殷信道[1] 马跃虎[1] JIN Mingxu;LI Lu;PENG Mingyang;YIN Xindao;MA Yuehu(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 21006,China;Department of Radiology,China-Japan Friendship Hospital,Beijing 10029,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,南京210006 [2]中日友好医院放射科,北京100029

出　　处：《磁共振成像》2020年第9期730-734,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：江苏省科技发展计划项目(编号:BE2017614)。

摘　　要：目的探讨急性大面积脑梗死患者机械血栓切除术(mechanical thrombectomy,MT)后预后的影响因素。材料与方法回顾性分析2017年1月至2019年10月收住入院并接受MT治疗的急性大面积脑梗死患者50例。大面积脑梗死定义为扩散加权成像(diffusion weighted imaging,DWI)-Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)≤5分。所有患者发病时间均为24 h内,且均于治疗前接受MRI检查。收集所有患者的DWI-ASPECTS评分、3个月功能预后(mRS评分)及一般临床资料等。应用多元逻辑回归分析预测卒中预后的独立预测因子。结果预后良好组(18例)血糖≤6.8 mmol/L比例明显高于预后不良组(32例)(66.67%与31.25%;χ^2=5.864,P=0.020);两组间DWI-ASPECTS评分无明显差异(4.75±0.25与4.35±0.38;t=2.898,P=0.170),然而预后良好组DWI-ASPECTS>2分患者比例明显高于预后不良组(88.89%与56.25%;χ^2=4.240,P=0.026)。多元逻辑回归分析显示血糖≤6.8 mmol/L(OR 4.05;95%CI:1.05~15.0;P=0.03)、DWI-ASPECTS>2分(OR 6.93;95%CI:1.05~45.76;P=0.04)为预测预后的独立预测因子。结论综合评估DWI-ASPECTS和血糖可以有效地判断急性大面积脑梗死患者的功能预后、指导治疗。Objective:To explore the risk factors of outcome after mechanical thrombectomy(MT)in acute large area infarction.Materials and Methods:In this retrospective study,fifty acute stroke patients who received MT from January 2017 to October 2019 in our hospital were enrolled.Large area infarction was defined as diffusion weighted imaging(DWI)-Alberta stroke program early CT score(ASPECTS)≤5 score.All patients≤24 hours of symptom onset and underwent MR examination before therapy.DWI-ASPECTS score,the functional outcome at 3 months(mRS)and other clinical data were collected.Multivariate logistic regression analysis was used to analyze the independent predictors of stroke.Results:The proportion of patients with blood glucose≤6.8 mmol/L in good functional outcome group(n=18)was significantly higher than that in the poor functional outcome(n=32)(66.67%vs 31.25%;χ^2=5.864,P=0.020).There was no significant difference in DWI-ASPECTS score between two groups(4.75±0.25 vs 4.35±0.38;t=2.898,P=0.170),while the proportion of patients with DWI-ASPECTS>2 score in good functional outcome group was significantly higher than that in the poor functional outcome(88.89%vs 56.25%;χ^2=4.240,P=0.026).Multivariable logistic analysis demonstrated that blood glucose≤6.8 mmol/L(OR,4.05;95%CI,1.05—15.0;P=0.03)and DWI-ASPECTS>2 score(OR,6.93;95%CI,1.05—45.76;P=0.04)were independently associated with functional outcome.Conclusions:Assessing blood glucose and DWI-ASPECTS could be useful for predicting functional outcome in acute stroke patients with large area infarction and guiding clinical treatment.

关 键 词：脑梗死 扩散加权成像 Alberta卒中项目早期CT评分 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.3[医药卫生—诊断学]