低灌注强度比值对老年急性前循环大血管闭塞性脑卒中患者机械取栓治疗预后的影响  

Prognostic value of hypoperfusion intensity ratio in elderly patients with acute ischemic stroke with large vessel occlusion of anterior circulation after mechanical thrombectomy

作　　者：孙爱成 曹月洲[1] 贾振宇[1] 赵林波[1] 施海彬[1] 刘圣[1] Sun Aicheng;Cao Yuezhou;Jia Zhenyu;Zhao Linbo;Shi Haibin;Liu Sheng(Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Jiangsu Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院介入放射科,江苏南京210029

出　　处：《中华介入放射学电子杂志》2024年第1期15-21,共7页Chinese Journal of Interventional Radiology：electronic edition

基　　金：江苏省省科技厅社会发展面上项目(BE2022809)。

摘　　要：目的探讨低灌注强度比值(hypoperfusion intensity ratio,HIR)对老年急性前循环大血管闭塞脑卒中(acute ischemic stroke with large vessel occlusion,AIS-LVO)患者机械取栓(mechanical thrombectomy,MT)治疗预后的影响。方法回顾性分析2020年1月至2023年1月在南京医科大学第一附属医院接受MT治疗的老年前循环AIS-LVO患者的资料。HIR是指脑血流达峰时间(time to maximum,Tmax)>10 s的脑组织体积与Tmax>6 s的脑组织体积的比值。根据术后90 d改良Rankin量表(mRS)评分,将患者分为预后良好组(mRS评分0~2分)和预后不良组(mRS评分为3~6分),比较两组患者的临床资料和影像学特征,并采用多因素Logistic回归分析确定治疗后90 d预后的影响因素。结果最终纳入93例患者,其中预后良好组22例,预后不良组71例。与预后不良组相比,预后良好组的患者核心梗死体积较小,HIR较低,基线美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分较低,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,HIR(OR=1.424,95%CI:1.022~1.984;P=0.037),侧支循环评分(OR=0.491,95%CI:0.263~0.915;P=0.025)以及基线NIHSS评分(OR=1.221,95%CI:1.077~1.385;P=0.002)是老年前循环AISLVO患者机械取栓预后的独立危险因素。结论较低的HIR与接受取栓的老年前循环AIS-LVO患者的良好预后相关。Objective To explore the prognostic value of the hypoperfusion intensity ratio(HIR)on 90-day clinical outcome after mechanical thrombectomy(MT)for acute ischemic stroke with large vessel occlusion(AIS-LVO)in elderly(≥80 years)patients.Methods We retrospectively analyzed the clinical data and imaging materials of the patients with large vessel occlusion,who received mechanical thrombectomy at the First Affiliated Hospital of Nanjing Medical University of China between January 2020 and January 2023.The HIR was defined as the Tmax(time to maximum)>10 s lesion volume divided by the Tmax>6 s lesion volume.According to the modified Rankin scale(mRS)score 90 d after operation,the patients were divided into favorable prognosis(mRS score≤2)group and poor prognosis(mRS score 3~6)group.The clinical and imaging data of the 2 groups were compared.The influencing factors of the prognosis 90 d after operation were determined by multivariate logistic regression analysis.Results A total of 93 patients were enrolled in this study,including 22 cases in the good prognosis group and 71 cases in the poor prognosis group.Compared with the patients in the poor prognosis group,the patients in the good prognosis group had a smaller core infarction volume,lower HIR and lower baseline National Institute of Health stroke scale(NIHSS)score with significant differences(all P<0.05).Multivariate Logistic regression analysis showed that HIR(OR=1.424,95%CI:1.022~1.984;P=0.037),collateral scoring(OR=0.491,95%CI:0.263~0.91;P=0.025)and baseline NIHSS(OR=1.221,95%CI:1.077~1.385;P=0.002)were independent predictors for prognosis of patients with anterior circulation AIS-LVO 90 d after MT aged≥80 years.Conclusion Low HIR was a predictor for favorable outcome in AIS patients aged≥80 years.

关 键 词：低灌注强度比值 急性大血管闭塞性卒中 机械取栓 老年人 

分 类 号：R743.3[医药卫生—神经病学与精神病学]