急性缺血性脑卒中平扫CT表现预测机械取栓后早期预后  

Non-contrast CT findings of acute ischemic stroke for predicting early prognosis after mechanical thrombectomy

作　　者：杨婧瑶 肖叶玉 张茜 邓方方 张株银 潘建军 罗庆华 代海洋[3] YANG Jingyao;XIAO Yeyu;ZHANG Qian;DENG Fangfang;ZHANG Zhuyin;PAN Jianjun;LUO Qinghua;DAI Haiyang(Department of Radiology,Guangzhou Hospital of Integrated Chinese and WesternMedicine Affiliated to Guangzhou University of Chinese Medicine,Guangzhou 510800,China;Department of Interventional,Guangzhou Hospital of Integrated Chinese and WesternMedicine Affiliated to Guangzhou University of Chinese Medicine,Guangzhou 510800,China;Department of Radiology,Huizhou central People’s Hospital,Huizhou 516008,China)

机构地区：[1]广州中医药大学附属广州中西医结合医院放射科,广东广州510800 [2]广州中医药大学附属广州中西医结合医院介入科,广东广州510800 [3]惠州市中心人民医院放射科,广东惠州516008

出　　处：《中国介入影像与治疗学》2024年第8期457-462,共6页Chinese Journal of Interventional Imaging and Therapy

基　　金：广州市花都区基础与应用基础区院共建项目(23HDQYLH17)。

摘　　要：目的观察以急性缺血性脑卒中(AIS)平扫CT表现预测机械取栓后早期预后的价值。方法回顾性分析161例来自中心1接受机械取栓的AIS患者,按照7∶3比例将其随机分为训练集(n=113)与内部测试集(n=48);以79例来自中心2同类患者为外部测试集。根据取栓后7天美国国立卫生研究院卒中量表(NIHSS)评分判断预后良好(<15分)或不良(≥15分),对比分析治疗前平扫CT表现。序贯以单因素及多因素logistic回归分析获取AIS机械取栓后早期预后的独立预测因素,建立预测模型并以列线图加以可视化。绘制受试者工作特征曲线,计算曲线下面积(AUC)评估区分度,通过Hosmer-Lemeshow拟合优度检验评估校准度,利用决策曲线分析(DCA)评估净收益。结果Alberta卒中项目早期CT评分(ASPECTS)、大脑中动脉高密度征(HMCAS)及基底神经节区钙化均为AIS机械取栓后早期预后的独立预测因素(P均<0.05);以之联合构建的预测模型及可视化列线图预测内部测试集预后的AUC为0.776(χ2=6.052,P=0.417),于外部测试集为0.800(χ2=2.269,P=0.811);DCA显示列线图可在一定阈值概率范围内带来临床净收益。结论ASPECTS、HMCAS及基底神经节区钙化均为AIS患者接受机械取栓后早期预后的独立预测因素;联合三者构建的预测模型及可视化列线图可较为准确地预测机械取栓后早期预后不良。Objective To explore the value of non-contrast CT findings of acute ischemic stroke(AIS)for predicting early prognosis after mechanical thrombectomy.Methods Data of 161 AIS patients from clinical center 1 who underwent mechanical thrombectomy were retrospectively analyzed.The patients were divided into training set(n=113)and internal test set(n=48)at the ratio of 7∶3,while 79 AIS patients who underwent mechanical thrombectomy from clinical center 2 were retrospectively enrolled as external test set.According to the National Institutes of Health stroke scale(NIHSS)scores 7 days after thrombectomy,patients’prognosis were classified as good(<15 points)or poor(≥15 points).Pretreatment non-contrast CT images of patients were reviewed,and CT findings were comparatively analyzed.Independent predictors of patients’early prognosis after mechanical thrombectomy were obtained with sequential univariate and multivariate logistic regressions,and a predicting model was established and visualized as a nomogram.The receiver operating characteristic curve was drawn,and the distinction was assessed with the area under the curve(AUC),then calibration was assessed with Hosmer-Lemeshow goodness of fit test,and the net benefit was evaluated with decision curve analysis(DCA).Results Alberta stroke program early CT score(ASPECTS),hyperdense middle cerebral artery sign(HMCAS)and basal ganglia calcification were all independent predictors of early prognosis of AIS after mechanical thrombectomy(all P<0.05).The predictive model was established combining the above 3 variables and then visualized as a nomogram to predict prognosis of AIS after mechanical thrombectomy,with AUC of 0.776 in internal test set(χ^(2)=6.052,P=0.417)and 0.800 in external test set(χ^(2)=2.269,P=0.811).DCA showed that the nomogram might provide clinical net benefit within certain threshold probability ranges.Conclusion ASPECTS,HMCAS and basal ganglia calcification were all independent predictors of early prognosis of AIS after mechanical thrombectomy.The nomo

关 键 词：卒中 体层摄影术 X线计算机 栓子清除术 预后 列线图 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R814.42[医药卫生—临床医学]