脑白质疏松严重程度与急性大血管闭塞性脑卒中机械取栓治疗预后的相关性研究  

Study on the Correlation between the Severity of Leukoaraiosis and the Prognosis of Acute Ischemic Stroke with Large Vessel Occlusion treated with Mechanical Thrombectomy

作　　者：席永 马春野[2] 孙大鹏 尹琳[2] XI Yong;MA Chunye;SUN Dapeng(Department of Neurology,Dalian Third People’s Hospital,Dalian 116033,China)

机构地区：[1]大连市第三人民医院神经内科,辽宁大连116033 [2]大连医科大学附属第二医院神经内科,辽宁大连116027 [3]首都医科大学附属北京天坛医院神经介入中心,北京100070

出　　处：《中风与神经疾病杂志》2022年第9期794-798,共5页Journal of Apoplexy and Nervous Diseases

基　　金：大连市第二批领军人才资助项目(No.2018-573-66)。

摘　　要：目的探究急性大血管闭塞性脑卒中(AIS-LVO)患者中脑白质疏松(LA)的严重程度是否与机械取栓(MT)治疗预后相关。方法选取2016年4月至2021年10月期间在我院卒中中心接受静脉溶栓(IVT)桥接MT或单纯接受MT治疗的AIS-LVO患者75例。根据Fazekas评分量表将LA的严重程度分为无至轻度组(0~2分,n=44)和中至重度组(3~6分,n=31),比较两组间的基线资料及MT术后结局;根据改良Rankin量表(mRS)对术后90 d预后进行评分,将90 d预后结果分为预后良好组(0~2分,n=32)及预后不良组(3~6分,n=43),根据单因素分析及多因素Logistic回归分析明确LA是否与MT术后90d预后相关。结果单因素分析结果显示,与无至轻度LA组相比,中至重度LA组的年龄更大(73.77±8.25 vs 63.00±10.50岁),女性比例更高(58.1%vs 22.7%),心房颤动比例更高(61.3%vs 36.4%),高脂血症比例更低(9.7%vs 29.5%),术后出血转化发生率更高(38.7%vs 13.6%),术后72 h症状性颅内出血发生率更高(19.4%vs 2%),无效再通率更高(78.6%vs 39.0%),术后90 d预后不良的发生率更高(80.6%vs 40.9%),两组间存在显著性差异(均P<0.05)。单因素分析结果显示,与预后良好组相比,预后不良组的年龄更大[69.0(63.0,77.0)vs 63.5(53.0,75.5)岁],基线NIHSS评分更高[(17.8±6.8)vs(12.3±4.9)分],空腹血糖水平更高[6.78(5.71,10.43)vs 5.88(5.29,6.95)mmol/L],中性粒细胞与淋巴细胞比值更高[4.48(1.92,8.11)vs 2.42(1.43,3.06)],糖尿病比例更高(37.2%vs 12.5%),中至重度LA的比例更高(58.1%vs 18.8%),两组间存在显著性差异(均P<0.05);多因素Logistic回归分析结果显示中至重度LA(OR=6.796,95%CI 1.564~29.530,P=0.011)与基线NIHSS评分(OR=1.156,95%CI 1.015~1.317,P=0.029)均是MT术后90 d预后不良的独立危险因素。结论中至重度LA可以独立预测AIS-LVO患者MT术后预后不良。Objective To explore whether the severity of LA in patients with acute ischemic stroke(AIS)with large vessel occlusion(AIS-LVO)was related to the prognosis of MT treatment.Methods A total of 75 AIS-LVO patients who received intravenous thrombolysis(IVT)bridging MT or MT alone were selected in the stroke center of our hospital from April 2016 to October 2021.According to the Fazekas score scale,the severity of LA was divided into non-mild group(0-2 points,n=44)and moderate-severe group(3~6 points,n=31).The baseline data and postoperative outcome of MT were compared between the two groups.The prognosis at 90 days after operation was evaluated by modified Rankin scale(mRS).The results were divided into two groups:good prognosis group(0~2 points,n=32)and poor prognosis group(3~6 points,n=43).Univariate analysis and multivariate Logistic regression analysis were used to determine whether LA was related to the prognosis of at 90 days after MT.Results Univariate analysis showed that compared with the non-mild LA group,the moderate-severe LA group had an older age[(73.77±8.25)vs(63.00±10.50)years old],higher female proportion(58.1%vs 22.7%),higher proportion of atrial fibrillation(61.3%vs 36.4%),lower proportion of hyperlipidemia(9.7%vs 29.5%),higher incidence of postoperative hemorrhage transformation(38.7%vs 13.6%),higher incidence of sICH at 72 hours after operation(19.4%vs 2%),higher rate of futile recanalization(78.6%vs 39.0%),and higher incidence of 90-day poor prognosis after operation(80.6%vs 40.9%).There were significant differences between two groups(all P<0.05).Univariate analysis showed that compared with the good prognosis group,the poor prognosis group had an older age[69.0(63.0,77.0)vs 63.5(53.0,75.5)years old],higher baseline NIHSS score[(17.8±6.8)vs(12.3±4.9)points],higher fasting blood glucose level[6.78(5.71,10.43)vs 5.88(5.29,6.95)mmol/L],higher neutrophil to lymphocyte ratio(NLR)[4.48(1.92,8.11)vs 2.4(1.43,3.06)],higher proportion of diabetes(37.2%vs 12.5%),and higher proportion of moderate-sever

关 键 词：急性缺血性脑卒中 脑白质疏松 机械取栓 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]