大脑中动脉M1段闭塞脑卒中患者脑血流变化规律及血小板活化状态与预后的关系  

Relationship between cerebral blood flow patterns and platelet activation status and prognosisin stroke patients with M1-segment obliteration of the middle cerebral artery

作　　者：刘玲 罗高权 刘琦 LIU Ling;LUO Gaoquan;LIU Qi(Southern Theater Command General Hospital,Guangzhou 510000,China;Dongguan Binhai Bay Central Hospital,Dongguan 523900,China)

机构地区：[1]南部战区总医院,广东广州510000 [2]东莞市滨海湾中心医院,广东东莞523900

出　　处：《中国实用神经疾病杂志》2024年第12期1510-1516,共7页Chinese Journal of Practical Nervous Diseases

基　　金：广东省省级科技计划项目(编号:2014A020212259)。

摘　　要：目的探究大脑中动脉M1段闭塞脑卒中患者脑血流变化规律及血小板活化状态与预后的相关性。方法选取2020-03—2022-03南部战区总医院收治的169例大脑中动脉M1段闭塞脑卒中患者,根据患者治疗后复发或死亡等不良事件发生情况分为预后良好组(118例)和预后不良组(51例)。利用多因素Logistic回归分析筛选大脑中动脉M1段闭塞脑卒中患者预后不良的独立影响因素,通过相加交互模型分析脑血流变化异常和血小板活化状态异常对患者预后不良的交互作用,利用受试者工作特征(ROC)曲线分析脑血流变化异常、血小板活化状态异常以及二者交互作用对患者预后不良的诊断价值,构建预后不良的列线图预测模型并进行评价。结果年龄、发病至治疗时间、C反应蛋白(CRP)、同型半胱氨酸(Hcy)、NIHSS评分、脑血流变化异常、血小板活化状态异常均是大脑中动脉M1段闭塞脑卒中患者预后不良的独立危险因素(P<0.05)。定量和定性分析显示,脑血流变化异常和血小板活化状态异常在患者预后不良风险中存在交互作用。ROC分析显示,脑血流变化异常和血小板活化状态异常的协同作用对大脑中动脉M1段闭塞脑卒中患者的诊断价值大于单一指标。基于7项独立预测因素构建的列线图模型验证结果显示,ROC曲线下面积(AUC)为0.827,C-index指数为0.816,Hosmer-Lemeshow拟合优度检验显示出较好的拟合度(P=0.378),具有较高的净获益值。结论年龄、发病至治疗时间、CRP、Hcy、NIHSS评分、脑血流变化异常、血小板活化状态异常均是大脑中动脉M1段闭塞脑卒中患者预后不良的独立危险因素,脑血流变化异常和血小板活化状态异常存在协同交互作用,二者同时发生增加患者预后不良的风险。Objective To investigate the correlation between cerebral blood flow patterns and platelet activation status and prognosis for patients with stroke suffered from middle cerebral artery M1 segment occlusion.Methods From March 2020 to March 2022,169 stroke patients with M1 segment middle cerebral artery blockage admitted to the Southern Theater Command General Hospital were selected.The patients were divided into the good prognosis group(118 cases)and the poor prognosis group(51 cases)according to whether they had adverse events,such as recurrence and death after treatment.A multifactorial regression approach was utilized to screen for separate factors influencing poor prognosis in stroke patients with M1 segment occlusion of the middle cerebral artery,and the interaction of abnormal cerebral blood flow changes and abnormal platelet activation status on poor prognosis was analyzed by summation interaction models.The diagnostic value of abnormal cerebral blood flow changes,abnormal platelet activation status and the interaction between the two in the diagnosis of poor prognosis was investigated by receiver operating characteristic(ROC)curves.The predicting model for the poor prognosis of stroke patients undergoing M1 segment occlusion in the middle cerebral artery was constructed and evaluated.Results Age,time from onset to treatment,C-reactive protein(CRP),homocysteine(Hcy),NIHSS score,abnormal cerebral blood flow levels and abnormal platelet activation status were all independent risk factors for negative prognosis in stroke patients with M1-segment occlusion of the middle cerebral artery(P<0.05).Quantitative and qualitative analysis showed an interaction between abnormal changes in cerebral haematology and the abnormal platelet activation status in the adverse prognosis.The results of the ROC analysis showed that the synergistic effect of abnormal cerebral blood flow changes and abnormal platelet activation status was of greater diagnostic value in stroke patients with M1 segment occlusion of the middle cerebral

关 键 词：脑卒中 大脑中动脉M1段 脑血流变化 血小板活化 交互作用 

分 类 号：R743.3[医药卫生—神经病学与精神病学]