性别对急性缺血性卒中机械取栓术后神经功能预后的影响  

The impact of gender on neurofunctional outcome after mechanical thrombectomy in patients with acute ischemic stroke

作　　者：高洁[1] 程哲[1] 姜尚前 耿晓坤[1] Gao Jie;Cheng Zhe;Jiang Shangqian;Geng Xiaokun(Department of Stroke Center,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京潞河医院卒中中心,101149

出　　处：《中国脑血管病杂志》2021年第1期30-36,共7页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨性别对大血管闭塞急性缺血性卒中患者机械取栓术后神经功能预后的影响。方法回顾性连续纳入2017年1月至2019年3月在首都医科大学附属北京潞河医院卒中中心接受机械取栓术治疗的大血管闭塞急性缺血性卒中患者200例,发病均在6 h内,年龄≥18岁,并经头部CT血管成像和(或)MR血管成像证实存在大血管闭塞,入院美国国立卫生研究院卒中量表(NIHSS)评分>6分且入院Alberta卒中项目早期CT(ASPECT)评分>5分。按照性别,将200例患者分为男性组(116例)和女性组(84例)。记录两组患者的年龄、入院NIHSS评分、入院ASPECT评分、危险因素(高血压病、糖尿病、心房颤动、吸烟)、闭塞部位、静脉溶栓、入院至再通时间、发病至再通时间、取栓次数、症状性颅内出血、死亡,并进行组间比较。取栓术后血管成功再通为脑梗死溶栓(TICI)分级≥2b级。主要终点事件为机械取栓术后90 d时的神经功能预后,改良Rankin量表(mRS)评分0~2分为预后良好,3~6分为预后不良。根据术后90 d时的神经功能预后情况,将200例患者分为预后良好组(112例)和预后不良组(88例),采用单因素对比及多因素Logistic回归方法分析性别等因素对大血管闭塞急性缺血性卒中患者机械取栓术后预后的影响。结果(1)男性组患者年龄、入院时NIHSS评分均低于女性组[(64±11)岁比(70±9)岁,t=4.524;16.0(14.0,18.0)分比17.5(15.0,20.0)分,Z=3.200],吸烟、颈动脉起始段闭塞比例均高于女性组[47.4%(55/116)比6.0%(5/84),χ2=39.882;18.1%(21/116)比2.4%(2/84),χ2=10.339],心房颤动比例低于女性组[30.2%(35/116)比57.1%(48/84),χ2=14.598],组间差异均有统计学意义(均P<0.01)。不同性别的两组患者入院时ASPECT评分、高血压病、糖尿病、大脑中动脉闭塞、颈内动脉末端闭塞、静脉溶栓、治疗至再通时间、发病至再通时间、取栓次数、TICI分级≥2b级的差异均无统计学意义(均P>0.0Objective To investigate the impact of gender on neurofunctional outcome after mechanical thrombectomy in patients with acute ischemic stroke patients(AIS)and large vessel occlusion(LVO).Methods From January 2017 to March 2019,200 AIS patients with LVO and who received mechanical thrombectomy at stroke center of Beijing Luhe Hospital,Capital Medical University were recruited.All patients had symptom onset within 6 h and aged≥18 years old.LVO was confirmed by head CT angiography and/or MR angiography.The National Institutes of Health stroke scale(NIHSS)score was>6,and the Alberta Stroke Program Early CT(ASPECT)score on admission>5.According to gender,200 patients were divided into male group(116 cases)and female group(84 cases).Age,NIHSS score at admission,ASPECT score at admission,risk factors(hypertension,diabetes,atrial fibrillation,smoking),occlusion site,intravenous thrombolysis,time from admission to recanalization,time from onset to recanalization,times of thrombectomy device passes,symptomatic intracranial hemorrhage and death were recorded and compared between the two groups.The thrombolysis in cerebral infarction(TICI)grade≥2b were successful recanalization.The primary end point was neurological function at 90 days after mechanical thrombectomy which was assessed by the modified Rankin scale(mRS).The mRS score of 0-2 was classified as good prognosis and 3-6 as poor prognosis.According to the prognosis of neurological function at 90 days after thrombectomy,200 patients w ere divided into good prognosis group(112 cases)and poor prognosis group(88 cases).Univariate analysis and multivariate Logistic regression were used to analyze the influence of gender and other factors on the prognosis of AIS patients with LVO after mechanical thrombectomy.Results(1)Compared with female group,the male group had lower age([64±11]years old vs.[70±9]years old,t=4.524)and lower baseline NIHSS score(16.0[14.0,18.0]vs.17.5[15.0,20.0],Z=3.200).The male group had significantly higher proportion of smoking and initial segme

关 键 词：急性缺血性卒中 脑动脉机械取栓术 功能预后 性别 

分 类 号：R743.3[医药卫生—神经病学与精神病学]