机械取栓治疗大血管闭塞性急性缺血性脑卒中首过效应预测因素  

Predictors of first pass effect of mechanical thrombectomy for treating acute ischemic stroke with large vessel occlusion

作　　者：陈正文 李沛城 刘一之[1] 李波[1] 袁晨[1] 侯凯文 陈珑[1] CHEN Zhengwen;LI Peicheng;LIU Yizhi;LI Bo;YUAN Chen;HOU Kaiwen;CHEN Long(Department of Intervention, the First Affiliated Hospital of Soochow University, Suzhou 215006, China)

机构地区：[1]苏州大学附属第一医学院介入科,江苏苏州215006

出　　处：《中国介入影像与治疗学》2022年第6期338-342,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的筛选机械取栓(MT)治疗大血管闭塞性急性缺血性脑卒中(AIS-LVO)获得首过效应(FPE)的预测因素。方法回顾性分析207例接受MT治疗的AIS-LVO患者,根据获得FPE与否分为FPE组(n=66)和非FPE组(n=141);比较组间一般资料、手术资料及术后情况,并将其中P<0.1者纳入logistic回归分析,筛选FPE预测因素;构建列线图模型,分析其预测效能。结果2组患者年龄、美国国立卫生研究院卒中量表(NIHSS)评分、艾伯塔卒中项目早期CT评分(ASPECTS)、血栓负荷评分(CBS)、闭塞位置、手术方式、手术时间、症状性颅内出血(sICH)率及预后差异均有统计学意义(P均<0.05)。年龄、高血压、ASPECTS、CBS、闭塞位置及手术方式均为MT FPE的独立预测因素;据此构建的列线图模型预测MT治疗AIS-LVO FPE的效能中等,其一致性指数为0.759[95%CI(0.629,0.889)]。结论根据AIS-LVO患者年龄、高血压、ASPECTS、CBS、闭塞位置及手术方式可预测MT FPE。Objective To screen the predictors of first pass effect(FPE)of mechanical thrombectomy(MT)for treating acute ischemic stroke with large vessel occlusion(AIS-LVO).Methods Data of 207 AIS-LVO patients who underwent MT were retrospectively analyzed.The patients were divided into FPE group(n=66)and non-FPE group(n=141)according to whether FPE was observed or not.The general data,surgical data and postoperative conditions were compared between groups,and those being different(P<0.1)between groups were enrolled for logistic regression analysis to screen the predictors of FPE.Nomogram model was constructed,and its prediction efficiency was analyzed.Results There were significant differences of patients'age,American National Institutes of Health stroke scale(NIHSS)score,Alberta stroke program early CT score(ASPECTS),clot burden score(CBS),occlusion location,operation method,operation time,symptomatic intracranial hemorrhage(sICH)rate and prognosis between groups.Age,hypertension,ASPECTS,CBS,occlusion location and operation method were all independent predictors of MT FPE.The obtained nomogram model had moderate efficacy for predicting FPE of MT for treating AIS-LVO,and the concordance index was 0.759(95%CI[0.629,0.889]).Conclusion AIS-LVO patient's age,hypertension,ASPECTS,CBS,occlusion location and operation method could be used to predict FPE of MT.

关 键 词：脑卒中 动脉闭塞性疾病 机械溶栓 支架 列线图 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R815[医药卫生—临床医学]