血栓通透性预测大脑中动脉闭塞性卒中患者血管内治疗后转归  

Thrombus permeability predicts the outcome after endovascular therapy in patients with middle cerebral artery occlusive stroke

作　　者：秦江彦 史孟容 王佳辉 范正 雷格格 李延静[1] 淡莉 Qin Jiangyan;Shi Mengrong;Wang Jiahui;Fan Zheng;Lei Gege;Li Yanjing;Dan Li(Department of Radiology,Cardiocerebrovascular Disease Hospital,the Affiliated Hospital of Yan'an University,Yan'an 716000,China;General Practice Department,Cardiocerebrovascular Disease Hospital,the Affiliated Hospital of Yan'an University,Yan'an 716000,China)

机构地区：[1]延安大学附属医院心脑血管病医院放射科,延安716000 [2]延安大学附属医院心脑血管病医院全科医学科,延安716000

出　　处：《国际脑血管病杂志》2024年第6期401-406,共6页International Journal of Cerebrovascular Diseases

基　　金：陕西省科协青年人才托举计划项目(20230315);延安市重点研发计划项目(2023SLSFGG-058)。

摘　　要：目的探讨血栓渗透性对大脑中动脉闭塞性卒中患者血管内治疗(endovascular therapy,EVT)后转归不良和有症状颅内出血(symptomatic intracranial hemorrhage,sICH)的预测价值。方法回顾性纳入2018年1月至2024年1月期间在延安大学附属医院心脑血管病医院接受EVT的大脑中动脉闭塞性卒中患者。应用血栓衰减增加值(thrombus attenuation increase,TAI)评估血栓渗透性。转归不良定义为术后90 d时改良Rankin量表评分>2分;sICH定义为EVT后7 d内相对基线或最低美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分增加≥4分且颅脑CT扫描显示脑出血。应用多变量logistic回归分析确定转归不良和sICH的独立影响因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价TAI对转归不良和sICH的预测价值。结果共纳入77例接受EVT治疗的大脑中动脉闭塞性卒中患者,男性44例(57.1%),年龄(62.1±12.4)岁。33例(48.1%)转归不良,35例(45.5%)发生出血性转化,其中12例(15.6%)为sICH。多变量logistic回归分析显示,TAI是转归不良[优势比(odds ratio,OR)0.930,95%置信区间(confidence interval,CI)0.883~0.980;P=0.007]和sICH(OR 0.868,95%CI 0.784~0.961;P=0.006)的独立影响因素。ROC曲线分析显示,TAI预测90 d时转归不良的曲线下面积为0.836(95%CI 0.742~0.930),截断值为10.135 HU,敏感性和特异性分别为73.0%和92.5%;TAI预测sICH的曲线下面积为0.750(95%CI 0.637~0.902),截断值为18.200 HU,敏感性和特异性分别为94.1%和64.5%。结论TAI对大脑中动脉闭塞性卒中患者EVT后转归不良和sICH有一定的预测价值。血栓渗透性较高的患者EVT后不易发生sICH,且转归良好的可能性较高。Objective To investigate the predictive value of thrombus permeability for poor outcome and symptomatic intracranial hemorrhage(sICH)after endovascular therapy(EVT)in patients with middle cerebral artery occlusion stroke.Methods Patients with middle cerebral artery occlusion stroke underwent EVT at the Cardiocerebrovascular Disease Hospital,the Affiliated Hospital of Yan'an University from January 2018 to January 2024 were included retrospectively.Thrombus attenuation increase(TAI)was used to evaluate thrombus permeability.The poor outcome was defined as a modified Rankin Scale score>2 at 90 days after procedure.sICH was defined as an increase of≥4 of the National Institutes of Health Stroke Scale(NIHSS)score relative to baseline or lowest within 7 days after EVT,and CT scan showed cerebral hemorrhage.Multivariate logistic regression analysis was used to determine the independent influencing factors of poor outcome and sICH.Receiver operating characteristic(ROC)curves was used to evaluate the predictive value of TAI for poor outcome and sICH.Results A total of 77 patients with middle cerebral artery occlusion stroke received EVT treatment were enrolled,including 44 males(57.1%),aged 62.1±12.4 years.Thirty-three patients(48.1%)had poor outcome,35(45.5%)experienced hemorrhagic transformation,of which 12(15.6%)were sICH.Multivariate logistic regression analysis showed that TAI(odds ratio[OR]0.930,95%confidence interval[CI]0.883-0.980;P=0.007)and sICH(OR 0.868,95%CI 0.784-0.961;P=0.006)were the independent influencing factors of poor outcome.ROC curve analysis showed that the area under the curve of TAI for predicting poor outcome at 90 days was 0.836(95%CI 0.742-0.930).The cut-off value was 10.135 HU.The sensitivity and specificity were 73.0%and 92.5%,respectively.The area under the curve of TAI for predicting sICH was 0.750(95%CI 0.637-0.902).The cut-off value was 18.200 HU.The sensitivity and specificity were 94.1%and 64.5%,respectively.Conclusions TAI has certain predictive value for poor outcome and sICH afte

关 键 词：缺血性卒中 颅内血栓形成 血管内手术 体层摄影术 X线计算机 CT血管造影术 治疗结果 颅内出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]