中青年前循环急性大血管闭塞性缺血性卒中患者血管内机械血栓切除术治疗效果及预后的影响因素  

Effect of endovascular mechanical thrombectomy in young and middle-aged patients with anterior circulation large vessel occlusion-acute ischemic stroke and influencing factors of prognosis

作　　者：徐姚 张仁伟[1] 刘煜敏[1] 刘振兴 XU Yao;ZHANG Renwei;LIU Yumin;LIU Zhenxing(Department of Neurology,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430000,China;Department of Neurology,Yiling People's Hospital of Yichang City,Yichang,Hubei 443100,China)

机构地区：[1]武汉大学中南医院神经内科,湖北武汉430000 [2]宜昌市夷陵人民医院神经内科,湖北宜昌443100

出　　处：《中华实用诊断与治疗杂志》2024年第1期81-85,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省重点研发计划项目(2020BCB028)。

摘　　要：目的 观察中青年(年龄18~50岁)前循环急性大血管闭塞性缺血性卒中(LVO-AIS)患者行血管内机械血栓切除术(MT)治疗的效果,探讨术后90 d预后不良的影响因素。方法 2019年1月—2022年8月武汉大学中南医院诊治中青年前循环LVO-AIS患者52例,均于发病24 h内行MT,依据术后90 d改良Rankin量表评分(mRS)分为预后良好组(mRS≤2分)和预后不良组(mRS>2分)。比较2组性别、年龄、合并症(高血压、糖尿病、心房颤动、冠心病、高脂血症)、吸烟史、血管闭塞部位、血管闭塞数量、TOAST病因分型及入院时美国国立卫生研究院卒中量表评分(NIHSS)、Alberta脑卒中早期CT诊断评分(ASPECTS)、中性粒细胞与淋巴细胞比值(NLR);比较2组静脉溶栓比率、发病至穿刺时间、发病至再通时间、穿刺至再通时间、取栓次数、球囊和/或支架植入比率、血管再灌注成功率、术后并发症(颅内出血、症状性颅内出血、肺部感染、下肢深静脉血栓形成)发生率;多因素logistic回归分析中青年前循环LVO-AIS患者MT术后90 d预后不良的影响因素;绘制ROC曲线,评估合并高血压、入院时ASPECTS对中青年前循环LVO-AIS患者MT术后90 d预后不良的预测效能。结果 (1)术后90 d时mRS≤2分29例,mRS>2分23例。预后良好组入院时ASPECTS[8.00(8.00,9.00)分]高于预后不良组[7.00(5.50,8.00)分](U=-2.944,P=0.003),合并高血压比率(20.69%)低于预后不良组(60.87%)(χ^(2)=7.134,P=0.008),2组年龄,TOAST病因分型,入院时NIHSS、NLR、血管闭塞部位及男性、糖尿病、高脂血症、心房颤动、冠心病、吸烟史、闭塞血管数量≥2支比率比较差异均无统计学意义(P>0.05)。(2)预后良好组术后血管再灌注成功率(93.10%)高于预后不良组(56.52%)(χ^(2)=7.719,P=0.005),2组发病至手术时间,发病至再通时间,穿刺至再通时间,取栓次数,静脉溶栓、球囊扩张和/或支架植入比率,症状性颅内出血、颅内出血、肺部感�Objective To observe the outcome of endovascular mechanical thrombectomy(MT) in young and middle-aged patients(aged 18 to 50 years) with anterior circulation large vessel occlusion-acute ischemic stroke(LVO-AIS),and to explore the influencing factors of 90-d poor prognosis after MT.Methods Fifty-two young and middle-aged patients with anterior circulation LVO-AIS were performed MT within 24 h after onset in Zhongnan Hospital of Wuhan University from January 2019 to August 2022,and were divided into good prognosis group [modified Rankin score(mRS)≤2] and poor prognosis group(mRS> 2) according to 90-d mRS after MT.The gender,age,comorbidities(hypertension,diabetes,atrial fibrillation,coronary heart disease,hyperlipidemia),smoking habits,vascular occlusion location,vascular occlusion number,TOAST etiology classification,National Institute of Health Stroke Ccale(NIHSS) score on admission,Alberta stroke program early CT score(ASPECTS),neutrophil to lymphocyte ratio(NLR),rate of intravenous thrombolysis,time from onset to puncture,time from onset to recanalization,time from puncture to recanalization,frequency of embolectomy,balloon and/or stent implantation rate,vascular reperfusion success rate and incidence of postoperative complications(intracranial hemorrhage,symptomatic intracranial hemorrhage,pulmonary infection and deep venous thrombosis of lower extremities) were compared between two groups.Multivariate logistic regression analysis was used to analyze the influencing factors of 90-d poor prognosis after MT in young and middle-aged patients with anterior circulation LVO-AIS.ROC curve was plotted to evaluate the predictive efficiencies of hypertension and admission ASPECTS on 90-d poor prognosis after MT.Results(1) The 90-d mRS after MT was <2 in 29 patients and> 2 in 23.The admission ASPECTS was higher in good prognosis group[8.00(8.00,9.00)] than that in poor prognosis group [7.00(5.50,8.00)](U=-2.944,P=-0.003),the rate of hypertension was lower in good prognosis group(20.69%) than that in poor prognosis gro

关 键 词：急性缺血性卒中 前循环大血管闭塞 机械取栓切除术 高血压 Alberta卒中项目早期CT评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]