颈动脉周围脂肪密度与急性缺血性脑卒中机械取栓的临床预后相关  

Association between carotid artery perivascular fat density and clinical prognosis after mechanical thrombectomy in patients with acute ischemic stroke

作　　者：朱成飞 陶涛涛 王文杰 张丹红 Zhu Chengfei;Tao Taotao;Wang Wenjie;Zhang Danhong(Department of Neurology,Taizhou Central Hospital(Affiliated Hospital of Taizhou University),Taizhou 318000,Zhejiang,China)

机构地区：[1]台州市中心医院(台州学院附属医院)神经内科,浙江台州318000

出　　处：《中国中西医结合急救杂志》2021年第4期416-421,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省台州市科技计划项目(1901ky40)。

摘　　要：目的探讨颈动脉周围脂肪密度与急性缺血性脑卒中(AIS)机械取栓患者临床预后的关系。方法回顾性连续纳入2017年6月至2020年12月在台州市中心医院接受机械取栓治疗的95例急性前循环大血管闭塞脑卒中患者。收集患者的临床资料,通过术前头颈部CT血管造影(CTA)评估取栓侧颈动脉周围脂肪密度,采用TOAST分型对患者病因分型.按照欧洲急性卒中协作组研究Ⅲ(ECASSⅢ)标准定义症状性颅内出血,通过改良Rankin量表(mRS)评分评估患者术后3个月的功能预后。对单因素分析中有差异的因素进行二元Logitie回归分析,绘制受试者工作特征曲线(ROC)评价颈动脉周围脂肪密度对AIS患者行机械取栓术后发生预后不良的预测价值。结果共纳入95例患者,其中非症状性颅内出血81例,症状性颅内出血14例。TOAST分型显示,大动脉粥样硬化性卒中(LAA)38例,心源性栓塞(CE)49例,其他类型8例。LAA患者颈动脉周围脂肪密度明显高于CE和其他类型患者(HU:-64.26±12.76比-75.16±13.77、-79.03±9.35.均P<0.01)。症状性颅内出血患者颈动脉周围脂肪密度明显高于非症状性颅内出血患者(HU:-61.02±11.84比-72.88±13.85.P<0.01);Logistie回归分析校正组间差异.结果具有统计学意义[优势比(OR)=1.107.95%可信区间(95%CI)为1.033~1.185.P=0.004];ROC曲线分析显示.颈动脉周围脂肪密度对症状性颅内出血的发生具有较高的预测价值[ROC曲线下面积(AUC)=0.755.95%CI为0.656~0.837.P<0.001]。预后不良患者颈动脉周周脂肪密度明显高于预后良好患者(HU:-65.92±1.47比-77.27±14.74.P<0.01);Lngistie回归分析校正组间差异.结果具有统计学意义(OR=1.108.95%CI为1.046~1.174.P=0.001);ROC曲线分析显示.颈动脉周围脂肪密度对患者3个月内预后不良的发生具有较高的预测价值(AUC=0.714.95%CI为0.607~0.805.P<0.001)。结论AIS患者的颈动脉周围脂肪密度与取栓治疗后症状性颅内出血以及3个月功能�Objective To investigale the relationship bretween carotid artery perivascular fat densily and elinical prognosis after mechanical thrombectomy in patients with arute ischemie stroke(AIS).Methods A relrospeetive study was conducted.A total of 95 consecutive patienls with AIS due to anterior rireulation large vessel orelusion hav ing undergone endovascular mechanical thrombectomy in the Taizhou Central Hospital were enrolled in the study from June 2017 to December 2020.The elinical data wer ollerted.The carotid artery prrivascular fat densily al the side of vascular thrombosis was evaluaterd by preoperative compulted tomography angiography(CTA)in head and neck.The ischemic stroke subtype of etiology for the patients was delermined acrording to TOAST criteria.Symptomatie intracranial henorrhage was defined according to European Cooperative Acule Stroke Sudy Ⅲ(ECASS Ⅲ)definition.The functional prognosis was evaluated by the modified Rankin scale(mRS)at 3 months after surgery.The factors with statistical significant dfferenre in single factor analysis were analyzed by binary Logistic regression analysis.The reeiver operator characteristir eurve(ROC)was drawn to evaluate the value of rarotie artery perivasrular fat density to predict the occurrence of poor prognosis after mechanical thrombectomy in patients with AIS.Results A total of 95 patients were included,including 81 rases of asymptomatic intracranial hermorhage and 14 rasrs of sy mplomatic intracranial hemorhage.TOAST lyping showed that 38 cases of large artery atherosclerosis(L.AA).49 cases of eardiogenic embolism(CE)and 81 cases of other lypes.The carotid artery perivascular fat densily in patients with LAA was significantly higher than that in patients with CE and other subtypes(HU:-64.26±12.76 vs.-75.16±13.77.-79.03±9.35.both P<0.01).Carotid artery perivascular fat density in patients with symptomatir intracranial hemorrhage was obviously higher than that in non-symplomatic intracranial hemorrhage patients(HU:-61.02±11.84 vs.-72.88±13.85.P<0.01).Af

关 键 词：血管周围脂肪密度 急性缺血性脑卒中 取栓 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]