核心梗死体积对大血管闭塞性急性缺血性脑卒中早期临床预后的预测价值  

Predictive value of core infarct volume in early clinical prognosis of acute ischemic stroke with large vessel occlusion

作　　者：李晓慧[1] 陈旭锋[1] 汪璇 茆丽娜[1] 王瑶[1] 杭宇 姜丽丽[1] 张劲松[1] 蒋雷[1] LI Xiaohui;CHEN Xufeng;WANG Xuan;MAO Lina;WANG Yao;HANG Yu;JIANG Lili;ZHANG Jinsong;JIANG Lei(Department of Emergency,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;School of Public Health,Nanjing Medical University,Nanjing 211166;Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊科,江苏南京210029 [2]南京医科大学公共卫生学院,江苏南京211166 [3]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2022年第12期1716-1721,1727,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省“六大人才高峰”资助项目(WSN-005);江苏省财政支持临床重点专科(YWC-ZKJS-2020-03);江苏省管医院专科建设项目(YWC-ZKJS-2021-01);临床能力提升工程(JSPH-MC-2021-5)。

摘　　要：目的:探讨核心梗死体积对大血管闭塞性急性缺血性脑卒中预后的影响。方法:回顾性分析南京医科大学第一附属医院急诊医学中心2020年1月1日—2021年12月31日行血管内治疗和/或静脉溶栓的大血管闭塞性急性缺血性脑卒中患者的相关临床和影像学资料。根据入院时和治疗72 h后美国国立卫生研究院卒中量表(NIHSS)评分改变值分为预后良好组和预后不佳组,分别比较两组基线资料特征,采用单因素和多因素回归分析预后不佳的危险因素。构建受试者工作特征(receiver operating characteristic,ROC)曲线,分析核心梗死体积对不良预后的预测能力。绘制核心梗死体积和预后不佳的概率以及优势比(odds ratio,OR)之间的关系曲线,分析预后不佳随核心梗死体积变化的趋势。结果:共计纳入131例患者,预后良好组83例,预后不佳组48例。基线资料显示,预后良好组核心梗死体积显著小于预后不佳组(P=0.041),预后良好组血管内治疗高于预后不佳组(P=0.040)。预后不佳的单因素回归分析显示,核心梗死体积(OR=1.012,95%CI:1.004~1.021,P=0.006)、出血并发症(OR=2.296,95%CI:1.028~5.181,P=0.043)、血管内治疗(OR=0.310,95%CI:0.106~0.851,P=0.025)、桥接(OR=0.443,95%CI:0.203~0.930,P=0.035)有统计学意义。多因素回归分析结果显示,核心梗死体积(OR=1.013,95%CI:1.005~1.022,P=0.003)是预后不佳的独立危险因素。ROC曲线提示核心梗死体积(AUC=0.60,95%CI:0.50~0.71)对预后不佳有较好的预测价值。非线性曲线表明,核心梗死体积≤31 mL,预后受核心梗死体积影响较小;核心梗死体积>31 mL,预后受核心梗死体积影响较大。结论:核心梗死体积是大血管闭塞性缺血性脑卒中患者预后的独立危险因素。Objective:To investigate the influence of core infarct volume on the prognosis of acute ischemic stroke with large vessel occlusion.Methods:Clinical and imaging data of patients with acute ischemic stroke who underwent endovascular therapy and/or intravenous thrombolysis from January 1,2020 to December 31,2021 in the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.According to the change value of the National Institutes of Health Stroke Scale(NIHSS)score at admission and 72 hours after treatment,the patients were divided into the good prognosis group and the poor prognosis group.The characteristics of baseline data of the two groups were compared,and the risk factors for poor prognosis were analyzed by univariate and multivariate regression.The receiver operating characteristic(ROC)curve was constructed to analyze the predictive ability of core infarct volume on adverse prognosis.The relationship between core infarction volume and the probability of poor prognosis as well as odds ratio(OR)was plotted,and the trend of poor prognosis with core infarction volume was analyzed.Results:A total of 131 patients were enrolled,83 in the good prognosis group and 48 in the poor prognosis group.Baseline data showed that the core infarct volume in the good prognosis group was significantly smaller than that in the poor prognosis group(P=0.041),and endovascular therapy in the good prognosis group was higher than that in the poor prognosis group(P=0.040).Univariate regression analysis of poor prognosis showed that core infarction volume(OR=1.012,95%CI:1.004~1.021,P=0.006),bleeding complications(OR=2.296,95%CI:1.028~5.181,P=0.043),endovascular therapy(OR=0.310,95%CI:0.106~0.851,P=0.025)and bridging(OR=0.443,95%CI:0.203~0.930,P=0.035)were statistically significant.Multivariate regression analysis showed that core infarct volume(OR=1.013,95%CI:1.005~1.022,P=0.003)was an independent risk factor for poor prognosis.ROC curve indicated that core infarct volume(AUC=0

关 键 词：急性缺血性脑卒中 大血管闭塞 CT灌注成像 核心梗死体积 早期预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]