急性缺血性脑卒中机械取栓后血栓形成相关因子对血管再闭塞的预测作用  

Role of thrombosis-related factors in predicting vascular reocclusion in AIS patients after mechanical thrombectomy

作　　者：李亮[1] 张继伟[1] 孙文浩[1] 王广[1] 田甜[1] 于淼[1] Li Liang;Zhang Jiwei;Sun Wenhao;Wang Guang;Tian Tian;Yu Miao(Department of Neurosurgery,Affiliated Hospital of Chengde Medical College,Chengde 067000,Hebei Province,China)

机构地区：[1]承德医学院附属医院神经外科,067000

出　　处：《中华老年心脑血管病杂志》2021年第5期503-506,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：承德市科学技术研究与发展计划项目(201804A031)。

摘　　要：目的急性缺血性脑卒中机械取栓后可溶性P选择素、血管性血友病因子(von Willebrand factor,vWF)、微栓子监测对血管再闭塞的预测作用。方法回顾性选取我院收治的228例急性缺血性脑卒中患者,均行机械取栓治疗,根据治疗后血管再闭塞情况分为血管通畅组(163例)、再闭塞组(65例)。比较2组患者临床资料、可溶性P选择素、vWF以及微栓子监测阳性情况等,采用logistic回归分析血管再闭塞的危险因素。用ROC曲线分析可溶性P选择素、vWF、微栓子监测对血管再闭塞的预测价值。结果血管通畅组发病后取栓时间、美国国立卫生研究院卒中量表(NIHSS)评分、可溶性P选择素、vWF以及微栓子监测阳性均明显低于再闭塞组(P<0.01)。logistic回归分析显示,发病后取栓时间(OR=1.627,95%CI:1.199~2.209)、NIHSS评分(OR=2.492,95%CI:1.302~4.767)、可溶性P选择素(OR=2.083,95%CI:1.338~3.244)、vWF(OR=2.547,95%CI:1.293~5.019)、微栓子阳性(OR=2.784,95%CI:1.139~6.806)是急性缺血性脑卒中患者机械取栓后血管再闭塞形成的独立危险因素(P<0.05,P<0.01)。可溶性P选择素诊断截断值为57.85μg/L,ROC曲线下面积为0.787(95%CI:0.736~0.831);vWF诊断截断值为78.32μg/L,ROC曲线下面积为0.803(95%CI:0.773~0.841),微栓子监测的ROC曲线下面积为0.778(95%CI:0.719~0.828)。微栓子监测的敏感性明显低于vWF(72.31%vs 89.23%,P<0.05),特异性明显高于可溶性P选择素、vWF(87.73%vs 76.69%、73.62%,P<0.01)。结论急性缺血性脑卒中机械取栓后可溶性P选择素、vWF、微栓子阳性均是血管再闭塞形成的独立危险因素,对于血管再闭塞的预测具有较高的诊断效能。Objective To study the role of soluble P-selectin,von Willebrand factor(vWF)and microembolus monitoring in predicting vascular reocclusion in AIS patients after mechanical thrombectomy.Methods Two hundred and twenty-eight AIS patients who underwent mechanical thrombectomy in our hospital were divided into vascular patency group(n=163)and vascular reocclusion group(n=65).The clinical data,soluble P-selectin,vWF and microembolus monitoring were compared between the two groups.The risk factors for vascular reocclusion were analyzed by logistic regression analysis.The role of soluble P-selectin,vWF and microembolus monitoring in predicting vascular reocclusion in AIS patients after mechanical thrombectomy was analyzed by ROC curve analysis.Results The time of thrombectomy and microembolic monitoring was significantly shorter,the NIHSS score and serum levels of soluble P-selectin and vWF were significantly lower in vascular patency group than in vascular reocclusion group(P<0.01).Logistic regression analysis showed that the time of thrombectomy,NIHSS score,serum levels of soluble P-selectin and vWF and positive microemboli were the independent risk factors for vascular occlusion in AIS patients after thrombectomy(OR=1.627,95%CI:1.199-2.209;OR=2.492,95%CI:1.302-4.767;OR=2.083,95%CI:1.338-3.244;OR=2.547,95%CI:1.293-5.019;OR=2.784,95%CI:1.139-6.806;P<0.05,P<0.01).The cutoff value of soluble P-selectin and vWF was 57.85μg/L and 78.32μg/L respectively.ROC curve analysis showed that the AUC for soluble P-selectin,vWF and microembolus monitoring was 0.787,0.803 and 0.778 respectively(95%CI:0.736-0.831,95%CI:0.773-0.841,95%CI:0.719-0.828).The sensitivity of microembolus monitoring was significantly lower than that of vWF(P=0.014)while the specificity of microembolus monitoring was significantly higher than that of soluble P-selectin and vWF in predicting vascular reocclusion in AIS patients(P<0.01).Conclusion Soluble P-selectin,vWF and positive microemboli are the independent risk factors for vascular reocclusion and play a

关 键 词：卒中 颅内栓塞和血栓形成 P选择素 von Willebrand因子 

分 类 号：R743.3[医药卫生—神经病学与精神病学]