前循环大血管闭塞性卒中患者血管内治疗后转归的影响因素  

Influencing factors of the outcome after endovascular treatment in patients with large vessel occlusive stroke in anterior circulation

作　　者：田鸿福 夏虹[2] 顾嘉晨 刘亮贤 杨位霞 刘明媛 Tian Hongfu;Xia Hong;Gu Jiachen;Liu Liangxian;Yang Weixia;Liu Mingyuan(Department of Neurology,Qingpu Branch,Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China;Department of Neurology,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210031,China)

机构地区：[1]复旦大学附属中山医院青浦分院神经内科,上海201700 [2]南京医科大学第四附属医院神经内科,南京210031

出　　处：《国际脑血管病杂志》2024年第10期735-740,共6页International Journal of Cerebrovascular Diseases

基　　金：上海市卫生科技发展专项资金项目计划(MY2023-11)。

摘　　要：目的探讨前循环大血管闭塞性卒中患者血管内治疗(endovascular therapy,EVT)后转归的影响因素。方法回顾性连续纳入2022年10月至2023年12月期间在复旦大学附属中山医院青浦分院和南京医科大学第四附属医院接受EVT治疗的前循环大血管闭塞性卒中患者。在发病后90 d应用改良Rankin量表进行转归评价,≤2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归分析确定EVT后转归不良的独立影响因素。结果从2家卒中中心总共纳入156例接受EVT治疗的前循环大血管闭塞性卒中患者,男性81例(51.9%),年龄(73.32±9.68)岁。69例(44.2%)转归良好,87例(55.8%)转归不良。单变量分析表明,转归良好组发病至入院时间、入院至股动脉穿刺时间、股动脉穿刺至再灌注时间、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、基线阿尔伯塔卒中项目早期CT评分(Alberta Stroke Program Early CT Score,ASPECTS)、核心梗死体积、缺血半暗带体积、改良脑梗死溶栓血流分级(modified Thrombolysis in Cerebral Infarction,mTICI)、术后任何颅内出血及有症状颅内出血与转归不良组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,基线NIHSS评分[优势比(odds ratio,OR)1.107,95%置信区间(confidence interval,CI)1.010~1.213;P=0.029]、入院至股动脉穿刺时间(OR 1.014,95%CI 1.000~1.028;P=0.048)、发病至入院时间(OR 1.006,95%CI 1.003~1.009;P<0.001)、核心梗死体积(OR 1.043,95%CI 1.004~1.084;P=0.029)以及mTICI<2b级(OR 10.117,95%CI 1.896~53.983;P=0.007)是转归不良的独立危险因素,而基线ASPECTS(OR 0.976,95%CI 0.961~0.991;P=0.002)和缺血半暗带体积(OR 0.359,95%CI 0.203~0.634;P<0.001)是转归良好的独立保护因素。结论对于前循环大血管闭塞性卒中患者,较高的基线NIHSS评分、较长的发病至入院时间和入院至股动脉穿刺时间、较大的核心梗死体积、mTICI<2b级与Objective To investigate the influencing factors of the outcome after endovascular therapy(EVT)in patients with large vessel occlusive stroke in anterior circulation.Methods Patients with large vessel occlusive stroke in anterior circulation received EVT at the Qingpu Branch of Zhongshan Hospital Affiliated with Fudan University and the Fourth Affiliated Hospital of Nanjing Medical University from October 2022 to December 2023 were included retrospectively.The modified Rankin Scale was used for outcome evaluation at 90 days after onset,≤2 points were defined as good outcome and>2 points were defined as poor outcome.Multivariate logistic regression analysis was used to identify independent influencing factors for poor outcome after EVT.Results A total of 156 patients with large vessel occlusive stroke in anterior circulation received EVT were enrolled from two stroke centers,including 81 males(51.9%),aged 73.32±9.68 years.Sixty-nine patients(44.2%)had good outcome,87(55.8%)had poor outcome.Univariate analysis showed that there were significant differences in the onset-to-door time,door-to-puncture time,puncture-to-reperfusion time,baseline National Institutes of Health Stroke Scale(NIHSS)score,baseline Alberta Stroke Program Early CT Score(ASPECTS),core infarct volume,ischemic penumbra volume,modified Thrombolysis in Cerebral Infarction(mTICI),postprocedural intracranial hemorrhage,and symptomatic intracranial hemorrhage between the good outcome group and the poor outcome group(all P<0.05).Multivariate logistic regression analysis showed that the baseline NIHSS score(odds ratio[OR]1.107,95%confidence interval[CI]1.010-1.213;P=0.029),door-to-puncture time(OR 1.014,95%CI 1.000-1.028;P=0.048),onset-to-door time(OR 1.006,95%CI 1.003-1.009;P<0.001),the core infarct volume(OR 1.043,95%CI 1.004-1.084;P=0.029),and mTICI<2b(OR 10.117,95%CI 1.896-53.983;P=0.007)were the independent risk factors for poor outcome,while baseline ASPECTS(OR 0.976,95%CI 0.961-0.991;P=0.002)and ischemic penumbra volume(OR 0.359,95%CI 0.203-0.6

关 键 词：缺血性卒中 血管内手术 血栓切除术 脑梗死 灌注成像 体层摄影术 X线计算机 治疗结果 

分 类 号：R74[医药卫生—神经病学与精神病学]