急性前循环缺血性卒中机械取栓术后快速神经功能改善的预测因素  

Predictors of rapid neurological improvement after mechanical thrombectomy in acute anterior circulation isch⁃emic stroke

作　　者：巨文盈 高旸 何雨轩 左朦 吴敏 JU Wenying;GAO Yang;HE Yuxuan(Department of Neurology,First Affiliated Hospital,Army Medi-cal University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院神经内科,重庆400038 [2]重庆市疾病预防控制中心,重庆400042

出　　处：《中风与神经疾病杂志》2024年第8期729-734,共6页Journal of Apoplexy and Nervous Diseases

基　　金：国家卫生健康委员会脑卒中高危人群筛查和干预项目(Z135080000022)。

摘　　要：目的探讨急性前循环缺血性卒中患者(AACIS)经机械取栓术(MT)后快速神经功能改善(RNI)的相关影响因素,并构建RNI的预测评分模型。方法对2017年1月—2021年10月在陆军军医大学第一附属医院与自贡市第三人民医院接受MT治疗的312例AACIS患者进行回顾性分析。采用单因素分析和多因素Logistic回归分析探讨患者RNI的独立影响因素,并对多因素分析有意义的指标赋分建立预测RNI的评分模型,采用受试者工作特征(ROC)曲线评估其预测价值。结果在312例AACIS患者中,159例(50.96%)具有RNI。多因素Logistic回归分析示糖尿病病史(OR=0.518;95%CI 0.290~0.926;P=0.027)与Van Swieten评分(3~4分)(OR=0.537;95%CI 0.294~0.981;P=0.043)是AACIS患者经MT后影响RNI的独立危险因素,术后mTICI分级(2b级或3级)(OR=3.912;95%CI 1.706~8.982;P=0.001)是其独立保护因素。构建的AACIS患者MT术后RNI预测评分模型的ROC曲线下面积为0.628(95%CI 0.565~0.690;P<0.001),最佳截断值为3分,敏感度为68.39%,特异度为52.98%。结论由AACIS患者糖尿病病史、术前Van Swieten评分、术后mTICI分级组成的预测评分模型对预测患者MT术后RNI具有良好的应用价值。Objective To investigate the factors influencing rapid neurological improvement(RNI)after mechanical thrombectomy(MT)in patients with acute anterior circulation ischemic stroke(AACIS),and to construct a predictive scoring model for RNI.Methods A retrospective study was conducted on 312 AAIS patients treated with MT at the Southwest Hospital and the Zigong Third People’s Hospital from January 2017 to October 2021.Univariate analysis and multivariate logistic regression analysis were performed to identify the independent factors influencing RNI.A scoring model for RNI prediction was established by assigning scores to significant variables in multivariate analysis.The prediction value was evaluated using the receiver operating characteristic(ROC)curve.Results Among the 312 AACIS patients,159(50.96%)demonstrated RNI.Multivariate logistic regression analysis showed that history of diabetes mellitus[odds ratio(OR)=0.518;95%confidence interval(CI)0.290–0.926;P=0.027]and Van Swieten score(3–4 points)(OR=0.537;95%CI 0.294–0.981;P=0.043)were independent risk factors for RNI in AACIS patients after MT.However,mTICI(grade 2b or 3)was an independent protective factor for RNI in patients with AACIS(OR=3.912;95%CI 1.706–8.982;P=0.001).The area under the ROC curve of the predictive scoring model was 0.628(95%CI 0.565–0.690;P<0.001).The optimal cut-off value was 3 points,the sensitivity was 68.39%,and the specificity was 52.98%.Conclusion The predictive scoring model consisting of history of diabetes mellitus,preoperative Van Swieten score,and postoperative mTICI grade is valuable in predicting RNI in patients with AACIS after MT.

关 键 词：急性前循环缺血性卒中 机械取栓术 快速神经功能改善 预测评分模型 

分 类 号：R743[医药卫生—神经病学与精神病学]