水摄取率对急性前循环大血管闭塞性卒中患者血管内治疗后早期神经功能改善的预测价值  

Predictive value of net water uptake with respect to early neurological improvement after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke

作　　者：廖安宇 吴航 程晓青 肖露露 黄抗默 陆梦霞 潘良源 菲罗拉·卡萨尔 姜洋洋 柳智惠 朱武生 Liao Anyu;Wu Hang;Cheng Xiaoqing;Xiao Lulu;Huang Kangmo;Lu Mengxia;Pan Liangyuan;Kasaer Feiluold;Jiang Yangyang;Liu Zhihui;Zhu Wusheng(Department of Neurology,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Department of Radiology,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China;Department of Neurology,Jinling Hospital Affiliated to Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)神经内科,南京210002 [2]南京大学医学院附属金陵医院(东部战区总医院)放射诊断科,南京210002 [3]南京医科大学金陵临床医学院(东部战区总医院)神经内科,南京210002

出　　处：《中华内科杂志》2023年第10期1172-1177,共6页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金(82271361);东部战区总医院临床研究续航专项(22LCYY-XH4)。

摘　　要：目的:研究影像学指标水摄取率(NWU)对急性前循环大血管闭塞性卒中患者血管内治疗后早期神经功能改善(ENI)的预测价值。方法:病例对照研究。回顾性纳入2014年10月至2019年9月就诊于南京大学医学院附属金陵医院诊断为急性前循环大血管闭塞性卒中接受血管内治疗,并且符合纳排标准的患者132例,男性80例、女性52例,年龄30~89岁,中位年龄68岁。根据是否发生ENI(定义为血管内治疗后24 h NIHSS评分改善4分或4分以上或NIHSS评分为0或1)将患者分为两组。运用秩和检验、 χ^(2)检验等方法比较两组患者基线特征差异,采用logistic回归探索患者术后ENI的独立预测因素,进一步运用受试者工作特征曲线分析NWU对ENI的预测效能。 结果:本研究共纳入132例患者,其中47例患者术后发生ENI,85例患者未发生。多因素logistic回归结果显示,年龄( OR=0.940,95% CI 0.903~0.979, P=0.003)、发病至穿刺时间( OR=0.995,95% CI 0.991~0.999, P=0.025)、穿刺至再通/手术结束时间( OR=0.985,95% CI 0.974~0.996, P=0.007)、NWU( OR=0.762,95% CI 0.620~0.937, P=0.010)、术后mTICI分级( OR=1.644,95% CI 1.043~2.590, P=0.032)为血管内治疗后ENI的预测因素。受试者工作特征曲线分析显示,NWU能够有效地预测患者术后ENI(曲线下面积0.642,95% CI 0.543~0.741, P=0.007),联合其他临床参数后预测效能提高。 结论:NWU是急性前循环大血管闭塞性卒中患者血管内治疗后ENI的独立预测因素。ObjectiveTo investigate the value of net water uptake(NWU)for predicting early neurological improvement(ENI)after endovascular treatment in patients with acute anterior circulation large vessel occlusion stroke.MethodsA case-control study.A total of 132 patients(80 men,52 women,median age 68 years)with acute anterior circulation large vessel occlusive stroke receiving endovascular treatment were retrospectively analyzed at Jinling Hospital from October 2014 to September 2019.Patients were divided into two groups based on the occurrence of ENI,which was defined as either an improvement of NIHSS score of≥4 points,or an NIHSS score of 0 or 1 at 24 hours after endovascular treatment.The rank sum test,Chi square test,and other methods were used to compare differences in baseline characteristics between the two groups.Logistic regression analysis was used to investigate independent predictors of postoperative ENI.Receiver operating characteristic curve analysis used to assess the capacity of NWU to predict ENI.ResultsOf the 132 patients in the study,ENI occurred in 47 and did not occur in 85.In multivariate logistic regression analysis age[odds ratio(OR)=0.940,95%confidence interval(CI)0.903-0.979,P=0.003],time from stroke onset to puncture(OR=0.995,95%CI 0.991-0.999,P=0.025),time from puncture to recanalization/end of operation(OR=0.985,95%CI 0.974-0.996,P=0.007),NWU(OR=0.762,95%CI 0.620-0.937,P=0.010),and mTICI(OR=1.644,95%CI 1.043-2.590,P=0.032)were predictive factors for ENI.Receiver operating characteristic curve analysis indicated that NWU could effectively predict ENI(area under the curve=0.642,95%CI 0.543-0.741,P=0.007),and prediction accuracy was improved when it was combined with other clinical parameters.ConclusionNWU is an independent predictor of ENI in patients with acute anterior circulation large vessel occlusive stroke undergoing endovascular treatment.

关 键 词：卒中 水摄取率 血管内治疗 早期神经功能改善 

分 类 号：R743.3[医药卫生—神经病学与精神病学]