性别对急性缺血性卒中患者机械取栓术预后的影响  

Effect of sex on prognosis after mechanical thrombectomy for acute ischemic stroke patients

作　　者：贾鹏 曹文博 杨斌[2] 谌燕飞[2] 王亚冰[2] 马青峰[3] 高鹏[2] 焦力群[2] Jia Peng;Cao Wenbo;Yang Bin;Chen Yanfei;Wang Yabing;Ma Qingfeng;Gao Peng;Jiao Liqun(the Second Clinical College of Binzhou Medical University,Yantai,Shandong 264100,China;不详)

机构地区：[1]滨州医学院第二临床医学院,山东省烟台市264100 [2]首都医科大学宣武医院神经外科 [3]首都医科大学宣武医院神经内科

出　　处：《中国脑血管病杂志》2024年第2期85-92,共8页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨性别差异对前循环急性大血管闭塞性卒中(AIS-LVO)患者机械取栓术预后的影响。方法回顾性连续纳入2019年1月至2021年12月在首都医科大学宣武医院神经外科接受机械取栓治疗的前循环AIS-LVO患者,于机械取栓术后90 d将改良Rankin量表(mRS)评分0~2分定义为预后良好,mRS评分3~6分定义为预后不良。收集患者基线资料(年龄、性别)、临床资料;临床资料包括血管疾病危险因素[高血压病、糖尿病、高脂血症、冠状动脉粥样硬化性心脏病(简称“冠心病”)、心房颤动、吸烟史、饮酒史、卒中史]、抗血小板聚集和抗凝药物使用史、基线美国国立卫生研究院卒中量表(NIHSS)评分、脑梗死分型、静脉溶栓、麻醉类型、发病至急诊时间、穿刺至血管再通时间(PTR)、发病至血管再通时间、基线Alberta卒中项目早期CT评分(ASPECTS)、闭塞部位、侧支循环状态、术后即刻再通情况。分别以性别、预后进行分组(男性组与女性组、预后不良组与预后良好组),比较两组患者基线和临床资料的差异。采用单因素Logistic回归分析性别在不同预后组间的差异,并采用Logistic多因素回归分析评估性别是否对机械取栓术患者的预后产生影响。结果共纳入了347例前循环AIS-LVO患者,其中女性组126例,男性组221例;预后良好组169例,预后不良组178例。(1)女性组患者年龄、心房颤动比例、基线NIHSS评分均高于男性组[70.5(59.0,80.0)岁比64.0(56.0,71.0)岁,Z=19.720;41.3%(52/126)比21.7%(48/221),χ^(2)=14.950;16(13,19)分比14(11,18)分,Z=9.670],吸烟、饮酒比例均低于男性组[5.6%(7/126)比54.8%(121/221),χ^(2)=83.420;3.2%(4/126)比49.8%(110/221),χ^(2)=78.990],组间差异均有统计学意义(均P<0.01);女性组和男性组患者脑梗死分型分布由高至低均为心源性栓塞[79.4%(100/126)、52.9%(117/221)]、大动脉粥样硬性[19.0%(24/126)、44.3%(98/221)]、其他型[1.6%(2/126)、2.7%(6/221)],Objective To investigate the effect of sex on the prognosis of mechanical thrombectomy in acute ischemic stroke with large vessel occlusion(AIS-LVO)patients.Methods Data of AIS-LVO patients due to anterior circulation vessel occlusion and receiving mechanical thrombectomy was reviewed and analyzed in Department of Neurosurgery of Xuanwu Hospital,Capital Medical University from January 2019 to December 2021.The modified Rankin scale(mRS)score 0-2 was classified as good prognosis,and mRS score 3-6 was classified as poor prognosis 90 days after mechanical thrombectomy.Baseline data(age,sex)and clinical data of patients were collected.Clinical data included vascular disease risk factors(hypertension,diabetes,hyperlipidemia,coronary atherosclerotic heart disease[CHD],atrial fibrillation,smoking history,drinking history,stroke history),antiplatelet and anticoagulation history,baseline National Institutes of Health stroke scale(NIHSS)score,cerebral infarction classification,intravenous thrombolysis,anesthesia type,onset-to-door time,puncture-to-recanalization time(PTR),onset-to-recanalization time,baseline Alberta stroke program early CT score(ASPECTS),occlusive site,collateral circulation status,and immediate postoperative recanalization status.The patients were grouped by sex and prognosis(male and female groups,poor and good prognosis groups),and the differences in baseline and clinical data between the two groups were compared.Univariate Logistic regression analysis was used to analyze the difference of sex between different prognostic groups,and multivariate Logistic regression analysis was used to evaluate whether sex had an effect on the prognosis of patients undergoing mechanical thrombectomy.Results All 347 AIS-LVO patients were enrolled,including 126 females and 221 males,178 poor and 169 good prognosis.(1)The age,atrial fibrillation rate and baseline NIHSS score of the female group were higher than those of the male group(70.5[59.0,80.0]years old vs.64.0[56.0,71.0]years old,Z=19.720;41.3%[52/126]vs.21.7%[48/2

关 键 词：卒中 机械取栓 性别差异 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]