大血管闭塞性急性缺血性卒中血管成功再通后恶性脑水肿的相关影响因素分析  

Analysis of related factors of malignant brain edema after successful vascular recanalization in acute ischemic stroke due to large vessel occlusion

作　　者：章礼勇 袁良津 施雪英 王雷 王玉[1] Zhang Liyong;Yuan Liangjin;Shi Xueying;Wang Lei;Wang Yu(Department of Neurology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230032,China)

机构地区：[1]安徽医科大学第一附属医院神经内科,合肥230032 [2]安徽医科大学附属安庆医院(安庆市立医院)神经内科

出　　处：《中国脑血管病杂志》2023年第5期325-333,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：安徽医科大学校科研基金资助项目(2021xkj238)。

摘　　要：目的分析大血管闭塞性急性缺血性卒中(AIS-LVO)血管成功再通后恶性脑水肿的相关影响因素。方法回顾性连续纳入安徽医科大学附属安庆医院国家脑卒中高级中心2020年4月至2022年10月经血管内治疗并实现早期血管内成功再通[改良脑梗死溶栓(mTICI)分级≥2b级]的前循环AIS-LVO患者114例,依据术后72 h内是否发生恶性脑水肿,将所患者分为恶性脑水肿组(40例)和无恶性脑水肿组(74例)。采用单因素分析方法分析两组患者的一般资料(年龄、性别、吸烟、饮酒)、既往病史(高血压病、糖尿病、高脂血症、高尿酸血症、高同型半胱氨酸血症、心房颤动、卒中病史)、入院收缩压、入院舒张压、入院美国国立卫生研究院卒中量表(NIHSS)评分、术前NIHSS评分、桥接治疗、发病至入院时间、发病至成功再通时间、急性卒中Org 10172治疗试验(TOAST)分型、闭塞血管、侧支循环、首过效应以及实验室检查[外周血白细胞计数(WBC)、外周血中性粒细胞计数与淋巴细胞计数比值(NLR)],将差异有统计学意义(P<0.05)的变量纳入多因素Logistic回归模型,筛选出独立影响因素,以受试者工作特征(ROC)曲线评估模型效果,通过随机森林图评估各影响因素对恶性脑水肿发生的重要性。结果与无恶性脑水肿组比较,恶性脑水肿组患者在心房颤动、入院NIHSS评分、术前NIHSS评分、外周血NLR、TOAST分型、闭塞血管、侧支循环不良、首过效应等方面差异均有统计学意义(均P<0.05)。多因素Logistic回归模型分析提示,术前高NIHSS评分(OR=1.124,95%CI:1.011~1.249,P=0.030)、高外周血NLR(OR=1.124,95%CI:1.031~1.225,P=0.008)、侧支循环不良(OR=4.408,95%CI:1.595~12.184,P=0.004)、非首过效应(OR=3.847,95%CI:1.444~10.251,P=0.007)是血管内治疗后恶性脑水肿的独立危险因素。回归模型ROC曲线下面积为0.846(95%CI:0.770~0.921,P<0.01),敏感度82.5%,特异度79.7%,Hosmer-Lemeshow拟合�Objective To analyze the related factors of malignant brain edema(MBE)after successful vascular recanalization in acute ischemic stroke due to large vessel occlusion of the anterior circulation.Methods A total of 114 patients of early intravascular successful recanalization(modified thrombolysis in cerebral infarction[mTICI]≥2b)by endovascular treatment(EVT)with acute ischemic stroke due to large vessel occlusion(AIS-LVO)of the anterior circulation were retrospectively included from April 2020 to October 2022 in the National Stroke Advanced Center,the First Affiliated Hospital of Anhui Medical University.Forty cases of MBE were included in the MBE group,and 74 cases without MBE were included in the non-MBE group after EVT.The general data(age,gender,smoking,drinking),formerly medical history(hypertension,diabetes,hyperlipidemia,hyperuricemia,hyperhomocysteinemia,atrial fibrillation,history of stroke),admission systolic blood pressure,admission diastolic blood pressure,admission National Institute of Health stroke scale(NIHSS)score,preoperative NIHSS score,bridging therapy,onset-to-admission time(ODT),onset-to-effective recanalization time(ORT),trial of Org10172 in acute stroke treatment(TOAST),occlusion of vessels,collateral circulation,first-pass effect(FPE),laboratory data(peripheral white blood cell[WBC]count,the ratio of peripheral blood neutrophil count and lymphocyte count[NLR])were compared between the two groups.The variables with statistical significance(P<0.05)were included in the multivariate Logistic regression model,and the independent influencing factors were screened out.The effectiveness of the model was evaluated by receiver operating curve(ROC)and the importance of the influencing factors of MBE was evaluated by random forest plot.Results Compared with the non-MBE group,there were significant differences in atrial fibrillation,admission NIHSS score,preoperative NIHSS score,peripheral blood NLR,TOAST,vessel occlusion,collateral circulation and FPE in MBE group(all P<0.05).The multivariate Logis

关 键 词：缺血性卒中 大血管闭塞 恶性脑水肿 机械取栓 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]