血管内治疗后发生无症状颅内出血的前循环大血管闭塞性卒中患者转归的影响因素  

Influencing factors of the outcome in patients with asymptomatic intracranial hemorrhage after endovascular therapy for large vessel occlusive stroke in anterior circulation

作　　者：李金蕊 柯健霞 符小丽 郑伟城[2] 石铸[2] Li Jinrui;Ke Jianxia;Fu Xiaoli;Zheng Weicheng;Shi Zhu(Department of Neurology,Nanyang Central Hospital,Nanyang 473000,China;Department of Neurology,the Tenth Affiliated Hospital of Southern Medical University,Dongguan 523109,China;Department of Neurology,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南阳市中心医院神经内科,南阳473000 [2]南方医科大学第十附属医院神经内科,东莞523109 [3]南方医科大学第三附属医院神经内科,广州510630

出　　处：《国际脑血管病杂志》2024年第9期654-660,共7页International Journal of Cerebrovascular Diseases

基　　金：广东省基础和应用基础研究粤莞联合重点项目(2021B1515120089)。

摘　　要：目的探讨血管内治疗(endovascular therapy,EVT)后发生无症状颅内出血(asymptomatic intracranial hemorrhage,aICH)的前循环大血管闭塞性卒中转归的影响因素。方法回顾性连续纳入2019年1月至2023年1月在东莞市人民医院接受EVT的前循环大血管闭塞性卒中患者。根据EVT后72 h内CT复查结果以及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分变化分为非ICH和aICH组。在发病后90 d时应用改良Rankin量表评价功能转归,>2分定义为转归不良。应用多变量logistic回归分析确定转归的独立相关因素。结果共纳入173例EVT后未发生颅内出血(intracranial hemorrhage,ICH)或发生aICH的患者,男性121例(69.9%),中位年龄64.0岁。64例(37.0%)EVT后发生aICH,其中44例(68.8%)为出血性梗死(hemorrhagic infarct,HI),20例(31.2%)为脑实质血肿(parenchymal hematoma,PH)。aICH组转归不良率显著高于非ICH组(42.2%对26.6%;χ^(2)=4.472,P=0.034);侧支循环不良的aICH患者中转归不良的患者比例显著高于所有非ICH患者(68.7%对26.6%;χ^(2)=11.388,P<0.001),而侧支循环良好组转归不良的患者比例与所有非ICH患者差异无统计学意义(23.5%对26.6%;χ^(2)=0.072,P=0.788)。在aICH患者中,侧支循环不良组PH(68.7%对11.8%;χ^(2)=14.561,P<0.001)以及转归不良(68.7%对23.5%;χ^(2)=7.209,P=0.027)的患者比例显著高于侧支循环良好组。多变量logistic回归分析显示,侧支循环不良[优势比(odds ratio,OR)3.84,95%置信区间(confidence interval,CI)1.07~12.76;P=0.039]、年龄较大(OR 1.07,95%CI 1.02~1.11;P=0.004)、血管未成功再通(OR 6.36,95%CI 1.74~23.23;P=0.005)和PH(OR 6.14,95%CI 1.83~20.58;P=0.003)是aICH患者转归不良的独立危险因素。结论在EVT后发生aICH的患者中,侧支循环良好组转归不良的患者比例与非ICH组相当,但侧支循环不良组发生脑实质出血和转归不良的风险显著增高。侧支循环不良是EVT后发生aICH的前循环大血管闭塞Objective To investigate the influencing factors of the outcome in patients with asymptomatic intracranial hemorrhage(aICH)after endovascular therapy(EVT)for large vessel occlusive stroke in anterior circulation.Methods Patients with large vessel occlusive stroke in anterior circulation underwent EVT at Dongguan People's Hospital from January 2019 to January 2023 were included retrospectively.According to the CT re-examination results within 72 hours after EVT and the changes in the National Institutes of Health Stroke Scale(NIHSS)score,the patients were divided into non-ICH group and aICH group.At 90 days after onset,the modified Rankin Scale was used to evaluate functional outcome,>2 points were defined as a poor outcome.Multivariate logistic regression analysis was used to determine the independent correlated factors for outcome.Results A total of 173 patients who did not experience intracranial hemorrhage(ICH)or experienced aICH after EVT were enrolled,including 121 males(69.9%),median aged 64.0 years.Sixty-four patients(37.0%)developed aICH after EVT,of which 44(68.8%)were hemorrhagic infarction(HI)and 20(31.2%)were parenchymal hematoma(PH).The incidence of poor outcome in the ICH group was significantly higher than that in the non-ICH group(42.2%vs.26.6%;χ^(2)=4.472,P=0.034).In aICH patients with poor collateral circulation,the proportion of patients with poor outcome was significantly higher than in all non-ICH patients(68.7%vs.26.6%;χ^(2)=11.388,P<0.001),while there was no significant difference in the proportion of patients with poor outcome in the good collateral circulation group compared to all non-ICH patients(23.5%vs.26.6%;χ^(2)=0.072,P=0.788).In aICH patients,the proportion of PH(68.7%vs.11.8%;χ^(2)=14.561,P<0.001)and poor outcome(68.7%vs.23.5%;χ^(2)=7.209,P=0.027)in patients with poor collateral circulation were significantly higher than that of good collateral circulation.Multivariate logistic regression analysis showed that poor collateral circulation(odds ratio[OR]3.84;95%confidence interv

关 键 词：缺血性卒中 血管内手术 血栓切除术 颅内出血 治疗结果 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]