预测急性前循环大血管闭塞患者机械取栓术后无效再通风险的列线图模型  

A nomogram model predicting futile recanalization in patients with acute anterior circulation large vessel occlusion after endovascular mechanical thrombectomy

作　　者：王小军 吴宗艺 彭慧渊 林铎 刘星辰 吴健恒 杨敏 温俊雄 Wang Xiaojun;Wu Zongyi;Peng Huiyuan;Lin Duo;Liu Xingchen;Wu Jianheng;Yang Min;Wen Junxiong(Department of Neurology,Zhongshan Hospital of Chinese Medicine,Guangzhou University of Chinese Medicine,Zhongshan 528400,China)

机构地区：[1]广州中医药大学附属中山中医院神经内科,中山528400

出　　处：《中华神经医学杂志》2023年第1期43-50,共8页Chinese Journal of Neuromedicine

基　　金：国家中医药管理局国家中医临床研究基地业务建设科研专项(JDZX2015296);广东省中医药重点学科建设项目((2021)129号);中山市社会公益与基础研究项目(2021B1065、2021B1069);中山市医学科研项目(2020J113)。

摘　　要：目的探讨急性前循环大血管闭塞患者行机械取栓术后无效再通的危险因素,构建预测患者机械取栓术后无效再通风险的列线图模型。方法选择广州中医药大学附属中山中医院神经内科自2018年1月至2021年12月采用血管内机械取栓术治疗的188例急性前循环大血管闭塞患者,根据是否发生无效再通将患者分成无效再通组和有效再通组[无效再通定义为术后即刻DSA显示成功实现血管再通(改良脑梗死溶栓分级≥2b级),但术后90 d患者功能转归不良(改良Rankin量表评分>2分)]。比较无效再通组和有效再通组患者的临床资料,采用多因素Logistic回归分析筛选影响无效再通的危险因素。采用R软件构建预测患者术后发生无效再通的列线图模型,采用C指数评估模型的区分度,采用校正曲线评估模型预测的准确性,采用受试者工作特征(ROC)曲线评价模型的预测效能。结果188例患者中发生无效再通92例。与有效再通组比较,无效再通组患者的年龄较大,入院时糖化血红蛋白水平较高,穿刺至血管再通时间较长,高血压病史、侧支循环不良者所占比例较高,脑卒中和脑白质高信号(WMHs)严重程度、闭塞部位的分布不同,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示年龄、高血压病史、穿刺至血管再通时间、侧支循环不良、重度WMHs、中度和重度脑卒中是急性前循环大血管闭塞患者行机械取栓术后发生无效再通的独立危险因素(P<0.05)。根据以上6个因素建立预测术后无效再通的列线图模型,C指数为0.862(95%CI:0.809~0.914),校准曲线显示该模型校准曲线接近理想曲线。ROC曲线分析显示该模型预测术后无效再通的曲线下面积为0.862(95%CI:0.809~0.914,P<0.001)。结论高龄、有高血压病史、穿刺至血管再通时间较长、侧支循环不良、重度WMHs、中度和重度脑卒中的急性前循环大血管闭塞患者行机械取�Objective To investigate the risk factors for futile recanalization in patients with acute anterior circulation large vessel occlusion after endovascular mechanical thrombectomy(EMT),and establish a nomogram model predicting futile recanalization in these patients.Methods One hundred and eighty-eight patients with acute anterior circulation large vessel occlusion after EMT were enrolled from Department of Neurology,Zhongshan Hospital of Chinese Medicine,Guangzhou University of Chinese Medicine from January 2018 to December 2021.Patients were divided into futile recanalization group and effective recanalization group according to whether futile recanalization occurred;futile recanalization was defined as successful recanalization showed by immediate postoperative DSA(modified thrombolysis in cerebral infarction[mTICI]≥2b),but poor functional outcome(modified Rankin Scale[mRS]scores>290 d after surgery).The clinical data were compared between futile recanalization group and effective recanalization group.Multivariate Logistic regression analysis was used to screen the risk factors for futile recanalization.R software was used to establish a nomogram model for futile recanalization.C-index was used to evaluate the differentiation of the model,and correction curve was used to evaluate the accuracy of the line graph model prediction.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficiency of the nomogram model.Results Ninety-two patients had futile recanalization.Compared with the effective recanalization group,futile recanalization group had significantly older age,significantly higher hemoglobin A1c on admission,significantly longer time from puncture to vascular recanalization,significantly higher proportions of patients with hypertension history and poor collateral circulation,and significantly different severities of stroke and white matter hyperintensities(WMHs)and distribution of occlusive sites(P<0.05).Multivariate Logistic regression analysis showed that age,history of hype

关 键 词：缺血性脑卒中 大血管闭塞 机械取栓 无效再通 列线图模型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]