ASPECTS不同梗死区域与前循环大血管闭塞性急性缺血性卒中机械取栓术后的预后分析  

Prognostic Analysis ofASPECTS Different Region in Patients with Acute Ischemic Stroke with Anterior Circulation Large Vessel Occlusionafter Mechanical Thrombectomy

作　　者：邹宇 涂江龙[2] 胡鹏鑫 朱涵婷 熊瑞芳 李承毅 唐小平[1,3] ZHOU Yu;TU Jianglong;HU Pengxin(Department of Radiology,The Second Affiliated Hospital,Jiangxi Medical College,Nanchang University,Nanchang 330006,P.R.China)

机构地区：[1]南昌大学第二附属医院医学影像中心,330006 [2]南昌大学第二附属医院神经内科,330006 [3]清华大学国家卓越工程师学院,生物医学工程学院,北京100084

出　　处：《临床放射学杂志》2024年第10期1649-1654,共6页Journal of Clinical Radiology

基　　金：江西省研究生创新专项基金资助项目(编号:YC2023-S183);江西省自然科学基金资助项目(编号:20232BAB206132)。

摘　　要：目的探讨ASPECTS不同梗死区域及其体积与急性前循环大血管闭塞性急性缺血性卒中(LVO-AIS)机械取栓(MT)术后的预后的关系。方法搜集南昌大学第二附属医院2021年1月至2023年10月经CTA或DSA检查证实为单侧急性前循环大血管(颈内动脉、大脑中动脉M1段和M2段近端)闭塞且接受MT治疗后再通的缺血性脑卒中患者的临床及影像资料。临床数据包括一般资料、基线美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分等。影像资料包括颅脑CT平扫、颅脑CT血管成像、颅脑CT灌注成像。根据术后3个月mRS评分将患者分为预后良好组(mRS≤2)和预后不良组(mRS≥3),通过软件评估术前核心梗死体积、缺血半暗带体积、Mismatch比值、ASPECTS总分、梗死部位及核心梗死体积占比。采用单因素及多因素Logistic回归分析影响患者预后的独立危险因素。通过相关性分析,绘制核心梗死体积占比与预后不良概率之间的关系曲线。最后采用ROC曲线评估相关指标的预测效能。结果共纳入97例患者,其中预后良好组61例,预后不良组36例。单因素分析显示,在临床指标中,预后良好组与预后不良组基线NIHSS评分、穿刺至再通时间及术后症状性脑出血有统计学意义。在影像指标中,两组之间核心梗死体积、Mismatch比值、ASPECTS总分及M1、M5、M6、内囊、尾状核梗死具有统计学意义。术前多因素分析显示,基线NIHSS评分及内囊、M6区域梗死是影响患者预后的独立危险因素。线性关系表明,内囊或M6区域核心梗死体积占比与预后不良成正相关。非线性关系表明,内囊和M6区域共同作用下核心梗死体积占比大于58.1%,预后与核心梗死体积占比相关性近乎线性增加。将基线NIHSS评分、梗死部位及其核心梗死体积占比联合评估预后的ROC曲线下面积(AUC)为0.88,敏感度75.0%,特异度93.4%。结论ASPECTS的不同区域对功能结局的Objective To explore the relationship between specific regional infarction and its volume and the prognosis of patients after mechanical thrombectomy for acute large vessel occlusion.Methods Clinical and imaging data were collected from patients with unilateral acute anterior circulation large vessel occlusion(internal carotid artery,proximal segments of the middle cerebral artery M1 and M2)confirmed by CTA or DSA,who underwent mechanical thrombectomy(MT)treatment and achieved recanalization at the Second Affiliated Hospital of Nanchang University from January 2021 to October 2023.Clinical data included general information,baseline National Institutes of Health Stroke Scale(NIHSS)scores,and modified Rankin Scale(mRS)scores,etc.Imaging data included non-contrast CT scan,CT angiography,andCT perfusion imaging.Patients were divided into the good prognosis group(mRS≤2)and the poor prognosis group(mRS≥3)based on the mRS score at the 90-day follow-up.Preoperative core infarct volume,ischemic penumbra volume,mismatch ratio,ASPECTS total score,infarct region,and the proportion of core infarct were assessed using software.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors affecting patient prognosis.Correlation analysis was performed to plot the relationship curve between the proportion of core infarct and the probability of poor prognosis.The predictive efficacy of related indicators was evaluated using ROC curves.Results A total of 97 patients were included in the study,with 61 in the good prognosis group and 36 in the poor prognosis group.Univariate analysis showed that there were statistically significant differences between the good and poor prognosis groups in terms of baseline NIHSS scores,puncture to recanalization time,and symptomatic intracranial hemorrhage among the clinical indicators.In the imaging indicators,core infarct volume,mismatch ratio,ASPECTS total score,and infarctions in the M1,M5,M6,internal capsule,and caudate nucleus were statistically sig

关 键 词：Alberta卒中项目早期CT评分 大血管闭塞 核心梗死部位 机械取栓 急性缺血性脑卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]