液体衰减反转恢复序列血管高信号-弥散加权成像不匹配与大脑中动脉M1段闭塞性卒中患者血管内机械血栓切除治疗后转归的相关性  

Correlation between fluid attenuation inversion recovery vascular hyperintensities-diffusion weighted imaging mismatch and the outcomes of endovascular mechanical thrombectomy in patients with middle cerebral artery M1 segment occlusive stroke

作　　者：尹宇轩 刘振生[1] 唐铁钰 张帅 张新江[1] Yin Yuxuan;Liu Zhensheng;Tang Tieyu;Zhang Shuai;Zhang Xinjiang(Department of Neurology,the Affiliated Hospital of Yangzhou University,Yangzhou 225009,China)

机构地区：[1]扬州大学附属医院神经内科,225009

出　　处：《国际脑血管病杂志》2021年第3期161-168,共8页International Journal of Cerebrovascular Diseases

基　　金：扬州市科技局社会发展重点研发项目(YZ2019054)。

摘　　要：目的探讨液体衰减反转恢复序列血管高信号(fluid-attenuated inversion recovery vascular hyperintensities,FVH)-弥散加权成像(diffusion-weighted imaging,DWI)不匹配与急性大脑中动脉M1段闭塞性卒中患者血管内机械血栓切除(endovascular mechanical thrombectomy,EMT)治疗后转归的相关性。方法回顾性纳入2016年1月至2020年6月在扬州大学附属医院接受EMT治疗且FLAIR显示存在FVH的大脑中动脉M1段闭塞性卒中患者。收集患者人口统计学和基本临床信息。在发病后3个月时应用改良Rankin量表进行转归评价,0~2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归分析确定临床转归的独立影响因素。结果共纳入77例患者,年龄(67.16±9.63)岁,男性51例(66.23%);基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(14.16±7.49)分。40例(51.95%)转归良好,37例(48.05%)转归不良。单变量分析显示,转归良好组FVH-DWI不匹配的患者构成比显著高于转归不良组(60.00%对29.73%;χ^(2)=7.103,P=0.008),而基线NIHSS评分[(11.60±4.44)分对(16.92±9.05)分;t=-3.312,P=0.001]和高血压患者的构成比(65.00%对86.49%;χ^(2)=4.774,P=0.029)显著低于转归不良组。多变量logistic回归分析表明,FVH-DWI不匹配与转归良好显著独立相关(优势比0.345,95%置信区间0.121~0.984;P=0.047),基线NIHSS评分与转归不良显著独立相关(优势比1.133,95%置信区间1.036~1.239;P=0.006)。结论FVH-DWI不匹配与急性大脑中动脉M1段闭塞性卒中患者EMT治疗后转归良好独立相关。Objective To investigate the correlation between fluid attenuated inversion recovery vascular hyperintensities(FVH)-diffusion weighted imaging(DWI)mismatch and the outcomes after endovascular mechanical thrombectomy(EMT)in patients with acute middle cerebral artery M1 segment occlusive stroke.Methods Patients with middle cerebral artery M1 segment occlusive stroke who received EMT treatment and whose FLAIR images showed FVH in the Affiliated Hospital of Yangzhou University from January 2016 to June 2020 were enrolled retrospectively.The demographics and basic clinical information of the patients were collected.The modified Rankin Scale was used to evaluate the outcomes at 3 months after the onset of symptoms.0-2 was defined as a good outcome,and>2 was defined as a poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome.Results A total of 77 patients were enrolled in the study.Their age was 67.16±9.63 years,51 were males(66.23%).The baseline National Institutes of Health Stroke Scale(NIHSS)score was 14.16±7.49.Forty patients(51.95%)had a good outcome,and 37(48.05%)had a poor outcome.Univariate analysis showed that the proportion of patients with FVH-DWI mismatch in the good outcome group was significantly higher than that in the poor outcome group(60.00%vs.29.73%;χ^(2)=7.103,P=0.008),and baseline NIHSS score(11.60±4.44 vs.16.92±9.05;t=-3.312,P=0.001)and the proportion of patients with hypertension(65.00%vs.86.49%;χ^(2)=4.774,P=0.029)were significantly lower than those in the poor outcome group.Multivariate logistic regression analysis showed that FVH-DWI mismatch was independently associated with the good outcomes(odds ratio[OR]0.345,95%confidence interval[CI]0.121-0.984;P=0.047),baseline NIHSS score was independently associated with the poor outcomes(OR 1.133,95%CI 1.036-1.239;P=0.006).Conclusion FVH-DWI mismatch was independently associated with the good outcomes after EMT treatment in patients with acute middle cerebral artery M1

关 键 词：卒中 脑缺血 梗死 大脑中动脉 血栓切除术 血管内手术 磁共振成像 治疗结果 

分 类 号：R743.3[医药卫生—神经病学与精神病学]