梗死核心容积预测急性前循环大血管闭塞患者机械取栓术后出血转化的价值  

The clinical value of infarction core volume in predicting hemorrhagic transformation in patients with acute anterior circulatory large vessel occlusion after receiving mechanical thrombectomy

作　　者：刘钦晨 贾振宇[1] 赵林波[1] 曹月洲[1] 周春高[1] 施海彬[1] 刘圣[1] LIU Qinchen;JIA Zhenyu;ZHAO Linbo;CAO Yuezhou;ZHOU Chungao;SHI Haibin;LIU Sheng(Department of Interventional Radiology,First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,210029

出　　处：《介入放射学杂志》2021年第8期756-760,共5页Journal of Interventional Radiology

摘　　要：目的探讨急性前循环大血管闭塞患者机械取栓术后梗死核心容积与出血转化(HT)的关系。方法回顾性分析2019年10月至2020年2月在南京医科大学第一附属医院接受机械取栓术治疗前循环大血管闭塞的急性缺血性脑卒中(AIS)患者临床和影像学资料。根据欧洲急性脑卒中协作研究(ECASS)Ⅱ标准,将患者分为HT组和Non-HT组,同时根据术后是否发生实质性血肿(PH)分为PH组和Non-PH组,分别比较两组患者临床资料。采用多因素logistic回归分析评估HT和PH独立危险因素,受试者工作特征曲线(ROC)分析梗死核心容积预测HT和PH的效能。结果共76例患者纳入分析。HT组26例,Non-HT组50例;PH组10例,Non-PH组66例。HT组梗死核心容积、美国国立卫生研究院卒中量表(NIHSS)评分及血糖水平均高于Non-HT组(P<0.05)。PH组梗死核心容积、NIHSS评分均高于Non-PH组(P<0.05)。多因素logistic回归分析显示,梗死核心容积较大是机械取栓术后发生HT的独立危险因素(OR=1.032,95%CI=1.003~1.061, P=0.028),也是发生PH的独立危险因素(OR=1.045,95%CI=1.007~1.085,P=0.021)。梗死核心容积预测HT的灵敏度为57.7%,特异度为72.0%,ROC曲线下面积(AUC)为0.658,预测值为13.5 mL;预测PH的灵敏度为54.5%,特异度为93.8%,AUC为0.755,预测值为36 mL。结论梗死核心容积较大是AIS患者机械取栓术后发生HT、PH的独立危险因素。梗死核心容积对AIS患者取栓术后HT具有预测价值。Objective To discuss the correlation between the infarction core volume and the hemorrhagic transformation(HT) in patients with acute anterior circulatory large vessel occlusion after receiving mechanical thrombectomy. Methods The clinical data and imaging materials of patients with acute ischemic stroke(AIS) caused by anterior circulatory large vessel occlusion, who were admitted to the First Affiliated Hospital of Nanjing Medical University of China to receive mechanical thrombectomy during the period from October2019 to February 2020, were retrospectively analyzed. According to European Cooperative Acute Stroke StudyⅡ(ECASS Ⅱ) criteria, the patients were divided into HT group and non-HT group, at the same time based on whether postoperative parenchymal hematoma(PH) occurred or not the patients were divided into PH group and non-PH group. The clinical data were compared between the two groups. Multivariate logistic regression analysis was used to evaluate the independent risk factors for HT and PH. Receiver operating characteristic(ROC) curve was adopted to assess the clinical value of the infarction core volume in predicting HT and PH.Results A total of 76 patients were enrolled in the analysis, including 26 patients in HT group and 50 patients in non-HT group. PH group had 10 patients and non-PH group had 66 patients. The infarction core volume, the National Institutes of Health Stroke Scale(NIHSS) score and blood sugar level in HT group were higher than those in non-HT group(P<0.05). The infarction core volume and NIHSS score in PH group were higher than those in non-PH group(P<0.05). Multivariate logistic regression analysis indicated that larger infarction core volume was an independent risk factor for HT occurring after mechanical thrombectomy(OR=1.032, 95%CI=1.003-1.061, P=0.028) and it was also an independent risk factor for PH(OR=1.045, 95%CI=1.007-1.085, P=0.021). The sensitivity and specificity of infarction core volume for predicting HT were 57.7% and 72.0%respectively, and the area under ROC cu

关 键 词：急性缺血性脑卒中 机械取栓术 出血转化 梗死核心容积 

分 类 号：R743.3[医药卫生—神经病学与精神病学]