非急性期症状性颅内大动脉闭塞脑梗死预后的影响因素  

Influencing factor of prognosis of symptomatic intracranial large artery occlusive cerebral infarction in nonacute phase

作　　者：张永梅[1] 王亚婷 胡甜甜 简溯 赵红领[2] 何文龙[2] ZHANG Yongmei;WANG Yating;HU Tiantian(Telemedicine Center,Affiliated Central Hospital of Xinxiang Medical College,Xinxiang 453000,China)

机构地区：[1]新乡市中心医院远程医学中心,453000 [2]新乡市中心医院神经介入科,453000

出　　处：《临床神经病学杂志》2025年第1期11-16,共6页Journal of Clinical Neurology

基　　金：2022年河南省医学科技攻关计划联合共建项目(LHGJ20220991);2021年新乡市软科学研究计划项目(RKX2020027)。

摘　　要：目的探讨非急性期症状性颅内大动脉闭塞(ILAO)脑梗死预后的影响因素。方法根据预后将86例非急性期症状性ILAO脑梗死患者分为预后良好组和预后不良组,比较两组的临床资料。采用多因素Logistic回归分析筛选出预后的影响因素,并将相关因素进行联合,构建预测非急性期ILAO脑梗死患者预后不良的列线图,通过校准曲线、决策曲线进行验证。结果与预后良好组比较,预后不良组患者的年龄、入院mRS、入院NIHSS评分、球蛋白水平及药物治疗比率显著升高,三酰甘油水平、白蛋白球蛋白比值显著降低(P<0.05~0.01)。多因素Logistic回归分析显示,入院mRS与非急性期ILAO脑梗死患者3个月预后不良呈正相关(OR=2.551,95%CI:1.134~5.738,P=0.024),血管内开通治疗与非急性期ILAO脑梗死患者3个月预后不良呈负相关(OR=0.132,95%CI:0.027~0.634,P=0.011)。纳入入院mRS及血管内开通治疗建立列线图模型,具有良好的预测效能。结论入院mRS和血管内开通治疗分别增加和降低非急性期ILAO脑梗死患者3个月预后不良的风险,两者结合建立的列线图对患者预后不良的预测具有良好的应用价值。Objective To investigate the influencing factor of prognosis of symptomatic intracranial large artery occlusive(ILAO)cerebral infarction in nonacute phase.Methods According to the prognosis,86 patients with symptomatic ILAO cerebral infarction in nonacute phase were divided into good prognosis group and poor prognosis group,and the clinical data of the two groups were compared.Multifactorial Logistic regression analysis was used to screen out the factors that influence prognosis.The related factors were combined to construct a nomogram for predicting poor prognosis of ILAO cerebral infarction in nonacute phase,validated by calibration curves and decision curve analysis.Results Compared with those in the good prognosis group,age,admission mRS,admission NIHSS score,globulin level and medication ratio in the poor prognosis group were significantly higher,and triacylglycerol level,albumin-globulin ratio in the poor prognosis group were significantly lower(P<0.05-0.01).Multifactorial Logistic regression analysis showed that admission mRS was positively associated with poor 3-month prognosis of patients with ILAO cerebral infarction in nonacute phase(OR=2.551,95%CI:1.134-5.738,P=0.024);endovascular opening therapy was negatively associated with poor 3-month prognosis of patients with ILAO cerebral infarction in the nonacute phase(OR=0.132,95%CI:0.027-0.634,P=0.011).Incorporating admission mRS and endovascular opening treatment to establish a nomogram had good predictive efficacy.Conclusions Admission mRS and endovascular recanalization treatment increased and decreased the risk of poor prognosis at 3 months in patients with ILAO cerebral infarction in nonacute phase,respectively.The nomogram established by combining the two has good application value in predicting the poor prognosis of patients.

关 键 词：非急性期症状性颅内大动脉闭塞性脑梗死 预后 血管内开通治疗 列线图 

分 类 号：R743.3[医药卫生—神经病学与精神病学]