急性基底动脉闭塞患者经机械取栓获得首过效应后预后不良预测因素  

Predictive factors of poor prognosis in patients with acute basilar artery occlusion who got first-pass effect after mechanical thrombectomy

作　　者：丁运 马圆 吕朋华 李沛城[1] 李波[1] 袁晨 李婉慈 顾典一 陈珑[1] DING Yun;MA Yuan;LYU P enghua;LI Peicheng;LI Bo;YUAN Chen;LI Wanci;GU Dianyi;CHEN Long(Department of Interventional Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Interventional Radiology,Northern Jiangsu People’s Hospital,Yangzhou 225009,China)

机构地区：[1]苏州大学附属第一医院介入放射科,江苏苏州215006 [2]苏北人民医院介入放射科,江苏扬州225009

出　　处：《中国介入影像与治疗学》2025年第2期81-85,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：江苏省医学会科研专项资金项目[SYH-3201140-0087(2023034)]。

摘　　要：目的探讨急性基底动脉闭塞(BAO)患者经机械取栓(MT)获得首过效应(FPE)后预后不良的预测因素。方法回顾性纳入82例MT后获得FPE的急性BAO患者并根据90天后改良Rankin量表(mRS)评分将其分为预后良好组(mRS评分≤3,n=48)与预后不良组(mRS评分>3,n=34);比较组间资料,将组间比较显示P<0.1的变量纳入多因素logistic回归分析,筛选急性BAO经MT获得FPE后预后不良的独立预测因素。结果与预后良好组相比,预后不良组患者年龄更大、治疗前美国国立卫生研究院卒中量表(NIHSS)评分及中性粒细胞与淋巴细胞比值(NLR)更高(P均<0.05),合并糖尿病、心房颤动(AF)及急性卒中Org 10172治疗试验(TOAST)分型心源性栓塞者占比亦更高(P均<0.05),而治疗前格拉斯哥昏迷量表(GCS)评分、后循环Alberta卒中项目早期CT评分(pc-ASPECTS)及基底动脉CT血管成像(BATMAN)评分更低(P均<0.05)。多因素logistic回归分析显示,合并AF[OR(95%CI)=29.769(1.470,602.943)]、治疗前NLR高[OR(95%CI)=1.212(1.016,1.446)]者预后相对不良(P均<0.05),而治疗前GCS评分[OR(95%CI)=0.615(0.429,0.882)]、pc-ASPECTS[OR(95%CI)=0.263(0.092,0.748)]及BATMAN评分较高者[OR(95%CI)=0.260(0.085,0.796)]预后相对较好(P均<0.05)。结论合并AF、治疗前低GCS评分、高NLR、低pc-ASPECTS及低BATMAN评分是急性BAO患者经MT获得FPE后预后不良的预测因素。Objective To observe the predictive factors of poor prognosis in patients with acute basilar artery occlusion(BAO)who got first-pass effect(FPE)after mechanical thrombectomy(MT).Methods Eighty-two acute BAO patients who got FPE following MT were retrospectively collected and divided into good prognosis group(modified Rankin scale[mRS]score≤3,n=48)and poor prognosis group(mRS score>3,n=34)90 days after treatments.The data were compared between groups,and variables which showed P<0.1 were included in multivariate logistic regression analysis to identify independent predictors of poor prognosis in acute BAO patients who got FPE after MT.Results Higher age of patients,pre-treatment National Institute Health stroke scale(NIHSS)and neutrophil-to-lymphocyte ratio(NLR),also higher proportions of patients with diabetes mellitus,atrial fibrillation(AF)and cardioembolic stroke in trial of org 10172 in acute stroke treatment(TOAST)classification were found in poor prognosis group than those in good prognosis group(all P<0.05).Conversely,patients in poor prognosis group had lower pre-treatment Glasgow coma scale(GCS)scores,lower posterior circulation-Alberta stroke program early CT score(pc-ASPECTS)and basilar artery on CT angiography(BATMAN)scores(all P<0.05).Multivariate logistic regression analysis revealed patients complicated with AF(OR[95%CI]=29.769[1.470,602.943])and elevated pre-treatment NLR(OR[95%CI]=1.212[1.016,1.446])had relatively poor prognosis(both P<0.05),whereas those with increased pre-treatment GCS score(OR[95%CI]=0.615[0.429,0.882]),elevated pc-ASPECTS(OR[95%CI]=0.263[0.092,0.748])and higher BATMAN score(OR[95%CI]=0.260[0.085,0.796])had relatively better prognosis(all P<0.05).Conclusion Complicated with AF,low pre-treatment GCS score,high NLR,low pc-ASPECTS and low BATMAN score were all predictive factors for poor prognosis in acute BAO patients who got FPE after MT.

关 键 词：脑梗死 基底动脉 机械溶栓 预后 

分 类 号：R543.5[医药卫生—心血管疾病] R815[医药卫生—内科学]