颅内前后循环急性脑卒中预后差异及影响因素研究  

The study of functional outcome difference and risk factors between intracranial anterior and posterior circulation in acute stroke patients

作　　者：吴含[1] 李璐 靳明旭[1] 彭明洋 殷信道[1] 王同兴[1] WU Han;LI Lu;JIN Mingxu;PENG Mingyang;YIN Xindao;WANG Tongxing(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China;Department of Radiology,China-Japan friendship hospital,Beijing 100029,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11期985-989,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：目的探讨颅内前后循环急性卒中预后差异及危险因素。材料与方法回顾性分析急性前循环脑卒中患者210例和后循环85例。所有患者发病时间为24 h之内,均于治疗前行MRI检查。按治疗方法将患者分为静脉溶栓治疗组及动脉取栓组。收集患者临床资料、扩散加权成像(diffusion-weighted imaging,DWI)梗死体积、血管再通程度(mTICI评分)及3个月预后(mRS评分)。统计学方法分析不同治疗组前后循环卒中患者预后差异及影响因素。结果200例静脉溶栓治疗患者中,前循环组(150例)DWI梗死体积明显大于后循环组(50例)(28.04±21.72与13.54±15.17;t=-4.077,P=0.023);然而前循环组预后良好比例明显高于后循环组(72.67%与42.00%;χ^2=15.502,P=0.000)。95例动脉取栓治疗患者中,前循环组(50例)DWI梗死体积明显大于后循环组(35例)(68.04±17.39与43.54±6.17;t=-2.170,P=0.037);血管再通率明显高于后循环组(mTICI评分2b^3分:78.33%与51.43%;χ^2=7.406,P=0.011);与后循环组相比,前循环组预后良好比例较高(70.00%与45.71%;χ^2=5.483;P=0.029)。逻辑回归分析显示DWI梗死体积[OR(95%CI):1.34(1.17~1.54);P=0.021]为预测卒中静脉溶栓治疗预后的独立预测因子;DWI梗死体积[OR(95%CI):1.19(1.07~2.85);P=0.034]、mTICI评分[OR(95%CI):3.88(1.27~11.78);P=0.016]为预测卒中动脉取栓治疗预后的独立预测因子。结论前循环卒中患者预后好于后循环卒中,综合评估卒中DWI梗死体积、血管再通程度可有助于预测卒中预后。Objective:To explore the functional outcome difference and risk factors between intracranial anterior and posterior circulation in acute stroke patients.Materials and Methods:Two hundred and ten acute anterior stroke patients and 85 acute posterior stroke patients in our hospital were retrospectively enrolled.All patients≤24 hours of symptom onset and underwent MRI examination before therapy.Patients were divided into intravenous thrombolysis group and arterial thrombectomy group.The clinical data,diffusion-weighted imaging(DWI)infarct volume,vascular recanalization(mTICI score)and the functional outcome at 3 months(mRS)were collected.Statistical analysis was performed to compare the functional outcome difference and risk factors between intracranial anterior and posterior circulation in acute stroke patients.Results:Of the 200 patients underwent intravenous thrombolysis,DWI infarct volume in the anterior circulation group(n=150)was significantly larger than that in posterior circulation group(n=50)(28.04±21.72 vs 13.54±15.17;t=-4.077,P=0.023);while the proportion of good functional outcome in the anterior circulation group was significantly higher than that in posterior circulation group(72.67%vs 42.00%;χ^2=15.502,P=0.000).Of the 95 patients underwent arterial thrombectomy,DWI infarct volume in the anterior circulation group(n=50)was significantly larger than that in posterior circulation group(n=35)(68.04±17.39 vs 43.54±6.17;t=-2.170,P=0.037),the vascular recanalization rate was significantly higher than that in posterior circulation group(mTICI score 2b—3:78.33%vs 51.43%;χ^2=7.406,P=0.011).Compared with the posterior circulation group,the functional outcome in the anterior circulation group was better(70.00%vs 45.71%);χ^2=5.483;P=0.029.Logistic regression analysis showed that DWI infarct volume[OR(95%CI):1.34(1.17—1.54);P=0.021]was independent predictor factors of functional outcome in acute stroke patients underwent intravenous thrombolysis.DWI infarct volume[OR(95%CI):1.19(1.07-2.85);P=0.034],mT

关 键 词：卒中 磁共振成像 前循环 后循环 预后 

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]