基于CTA的侧支循环评分对大血管闭塞性急性缺血性脑卒中的应用价值研究  

Application of collateral circulation scoring based on CTA in acute ischemic stroke with large vessel occlusion

作　　者：鲍红图 李志强[1] BAO Hongtu;LI Zhiqiang(Department of Interventional Radiology&Vascular Surgery,the Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院介入血管外科,保定071000

出　　处：《浙江医学》2024年第10期1047-1055,共9页Zhejiang Medical Journal

摘　　要：目的比较4种基于CTA的侧支循环评分[大脑中动脉闭塞远端血管侧支循环评分(Miteff评分),外侧裂、脑凸面侧支循环评分(Maas评分),大脑中动脉区域侧支循环评分(Tan评分),区域软脑膜侧支循环评分(rLMC评分)]的临床应用价值。方法回顾性分析2020年9月至2023年9月河北大学附属医院收治的98例AIS-LVO患者临床及影像学资料,根据2位医师的Miteff评分、Mass评分、Tan评分、rLMC评分结果,探究4种评分的评估者间信度;以基于数字减影血管造影(DSA)的侧支循环分级系统——美国介入和治疗神经放射学学会/美国介入放射学会(ASITN/SIR)分级结果为参考,探究该4种评分对侧支循环的评估效度;采用单因素分析、多因素二元logistic回归分析探究AIS-LVO患者预后的独立影响因素,并进一步通过ROC曲线评估不同评分对患者预后的预测价值。结果4种基于CTA的侧支循环评分的评估者间信度从高到低依次是rLMC评分、Miteff评分、Tan评分、Maas评分(Kappa=0.810、0.797、0.745、0.733,均P<0.05),评估效度从高到低依次是rLMC评分、Miteff评分、Tan评分、Maas评分(rs=0.687、0.534、0.481、0.423,均P<0.05)。入院血糖(OR=0.438,95%CI:0.196~0.975)、入院美国国立卫生研究院卒中评分量表(NIHSS)评分(OR=0.837,95%CI:0.699~1.002)是AIS-LVO患者预后的独立影响因素(均P<0.05);Miteff评分(OR=0.055,95%CI:0.007~0.461)、Maas评分(OR=0.047,95%CI:0.006~0.391)、Tan评分(OR=0.122,95%CI:0.020~0.721)、rLMC评分(OR=0.080,95%CI:0.014~0.460)评估的良好侧支循环均是AIS-LVO患者预后的独立影响因素(均P<0.05)。ROC曲线分析显示,4种评分对患者预后的预测价值从高到低依次是rLMC评分、Miteff评分、Tan评分、Maas评分(AUC=0.812、0.773、0.720、0.705,均P<0.05),最佳截断值分别为10.5、2.5、1.5、2.5分。结论rLMC评分对比其余3种评分(Miteff评分、Mass评分、Tan评分)评估者间信度最高、对侧支循环的评估效度最高�Objective This study aimed to investigate the inter-rater reliability and assessment validity of four collateral circulation scoring systems based on CTA:Miteff score(distal collateral branch score for middle cerebral artery occlusion),Maas score for lateral fissure,cerebral convexity collateral branch,Tan score for regional collateral branch of middle cerebral artery,and regional leptomeningeal collateral score(rLMC score).Additionally,it aimed to explore the predictive value for the prognosis of mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)and investigate the independent prognostic factors,thereby aiding in the clinical assessment of collateral circulation and selection of treatment strategies.Methods A retrospective analysis was conducted on clinical and imaging data of 98 patients with AIS-LVO treated by the Affiliated Hospital of Hebei University from September 2020 to September 2023.The inter-rater reliability of four scoring systems was explored based on the assessments of two physicians using Miteff score,Mass score,Tan score,and rLMC score.With the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)grading system based on digital subtraction angiography(DSA)as reference,the validity of these four scores in evaluating collateral circulation was investigated.Univariate and multivariate binary logistic regression analyses were employed to identify independent prognostic factors for AIS-LVO patients.Furthermore,the predictive value of different scores for patient prognosis was compared through ROC curve analysis.Results In terms of inter-rater reliability of the four CTA-based collateral circulation scores,rLMC score ranked the first,followed by Miteff score,Tan score,and Maas score successively(Kappa=0.810,0.797,0.745,0.733,respectively;all P<0.05),and the result was the same in terms of the validity of assessment(rs=0.687,0.534,0.481,0.423,respectively;all P<0.05).The blood glucose(OR=0.438,95

关 键 词：急性缺血性卒中 CT血管造影 侧支循环 机械取栓 

分 类 号：R743.3[医药卫生—神经病学与精神病学]