血管内治疗后完全再通的急性基底动脉闭塞患者转归的预测因素  

Predictive factors for the outcome of patients with complete recanalization after endovascular therapy for acute basilar artery occlusion

作　　者：胡迪 贾振宇[2] 闻芳 贾婷 喻丽芝 赵林波[2] 刘圣[2] 夏成才 Hu Di;Jia Zhenyu;Wen Fang;Jia Ting;Yu Lizhi;Zhao Linbo;Liu Sheng;Xia Chengcai(Department of Neurology,Pukou People's Hospital,Nanjing 210000,China;Department of Interventional Radiology,Jiangsu Provincial People's Hospital,Nanjing 210000,China)

机构地区：[1]南京市浦口人民医院神经内科,南京210000 [2]江苏省人民医院介入放射科,南京210000

出　　处：《国际脑血管病杂志》2024年第10期721-727,共7页International Journal of Cerebrovascular Diseases

基　　金：南京市浦口区社会事业科技发展项目(S2024-2,S2020-5);南京医科大学科技发展基金项目(NMUB20210371)。

摘　　要：目的探讨血管内治疗(endovascular therapy,EVT)完全再通的急性基底动脉闭塞(acute basilar artery occlusion,ABAO)患者转归的预测因素。方法回顾性纳入2015年1月至2022年12月在江苏省人民医院和南京市浦口人民医院接受EVT的ABAO患者。完全再通定义为EVT后改良脑梗死溶栓分级(modified Thrombolysis in Cerebral Infarction,mTICI)为3级。主要转归指标为发病后90 d时采用改良Rankin量表判定的临床转归,0~2分定义为转归良好,>2分定义为转归不良;次要转归指标为发病后90 d内死亡。应用多变量logistic回归分析确定转归不良和死亡的独立预测因素,应用受试者工作特征(receiver operating characteristic,ROC)曲线分析独立预测因素对转归不良或死亡的预测价值。结果共纳入73例EVT后完全再通的ABAO患者,男性55例(75.3%),年龄(67.2±1.58)岁,中位基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分23分,中位基线基底动脉CT血管成像(basilar artery on computed tomography angiography score,BATMAN)评分7分,中位基线后循环阿尔伯塔卒中项目早期CT评分(posterior circulation Alberta Stroke Program Early CT Score,pc-ASPECTS)8分。发病后后90 d时有34例(46.6%)转归不良,16例(21.9%)死亡。多变量logistic回归分析显示,基线NIHSS评分较高[优势比(odds ratio,OR)1.151,95%置信区间(confidence interval,CI)1.041~1.273;P=0.006]、基线pc-ASPECTS较低(OR 0.096,95%CI 0.024~0.386;P=0.001)、基线BATMAN评分较低(OR 0.394,95%CI 0.162~0.961;P=0.041)以及非首过再通(OR 5.011,95%CI 1.675~23.343;P=0.016)与转归不良独立相关。ROC曲线分析显示,联合这些独立预测因素预测转归不良的曲线下面积为0.966(95%CI 0.930~0.964)。多变量logistic回归分析显示,年龄较大(OR 1.147,95%CI 1.010~1.303;P=0.035)、基线NIHSS评分较高(OR 1.236,95%CI 1.040~1.470;P=0.016)、基线pc-ASPECTS评分较低(OR 0.011,95%CI 0.002~0.249;P=0.015)和基线BATMAN评分较Objective To investigate the predictive factors for the outcome of patients with complete recanalization after endovascular treatment(EVT)for acute basilar artery occlusion(ABAO).Methods Patients with ABAO underwent EVT at Jiangsu Provincial People's Hospital and Nanjing Pukou People's Hospital from January 2015 to December 2022 were included retrospectively.Complete recanalization was defined as a modified Thrombolysis in Cerebral Infarction(mTICI)grade 3 after EVT.The main outcome measure was the clinical outcome evaluated by the modified Rankin Scale at 90 days after onset.0-2 points were defined as good outcome and>2 points were defined as poor outcome.The secondary outcome measure was death within 90 days after onset.Multivariate logistic regression analysis was used to determine the independent predictive factors for poor outcome and mortality.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of the independent predictive factors for poor outcome or mortality.Results A total of 73 patients with completed recanalization after EVT for ABAO were enrolled,including 55 males(75.3%),aged 67.2±1.58 years,with the median baseline National Institutes of Health Stroke Scale(NIHSS)score 23,median baseline Basilar Artery on Computed Tomography Angiography(BATMAN)score 7,and median baseline posterior circulation Alberta Stroke Program Early CT Score(pc-ASPECTS)8.After 90 days of onset,34 patients(46.6%)had poor outcome and 16(21.9%)died.Multivariate logistic regression analysis showed that higher baseline NIHSS score(odds ratio[OR]1.151,95%confidence interval[CI]1.041-1.273;P=0.006),lower baseline pc-ASPECTS(OR 0.096,95%CI 0.024-0.386;P=0.001),lower baseline BATMAN score(OR 0.394,95%CI 0.162-0.961;P=0.041),and non-first-pass recanalization(OR 5.011,95%CI 1.675-23.343;P=0.016)were independently associated with the poor outcome.ROC curve analysis showed that the area under the curve for predicting poor outcome by combining these independent predictive factors was 0.966(95%CI 0.930-0.964

关 键 词：缺血性卒中 动脉闭塞性疾病 基底动脉 血管内手术 血栓切除术 治疗结果 危险因素 

分 类 号：R74[医药卫生—神经病学与精神病学]