超声心动图参数与急性缺血性脑卒中发病3个月时残疾的相关性  

Correlation of echocardiographic parameters with disability at 3 months after acute ischemic stroke

作　　者：杨博[1] 潘新芳 常留辉 倪勇[1] Yang Bo;Pan Xinfang;Chang Liuhui;Ni Yong(Department of Anesthesiology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院麻醉科,江苏省苏州市215004

出　　处：《中国组织工程研究》2025年第35期7544-7551,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(81601147),项目负责人:杨博;苏州市卫生青年骨干人才“全国导师制”培训项目(Qngg2024006),项目负责人:杨博;苏州市应用基础研究(医疗卫生)科技创新青年项目(SYW2024082),项目负责人:杨博。

摘　　要：背景:经胸超声心动图和斑点追踪超声心动图参数与脑卒中的发生和预后密切相关,然而,关于经胸超声心动图与三维斑点追踪超声心动图参数对急性缺血性脑卒中患者发病后功能残疾的影响尚不清楚。目的:探讨经胸超声心动图与三维斑点追踪超声心动图参数与急性缺血性脑卒中患者发病3个月时功能残疾的相关性。方法:前瞻性纳入2020年12月至2022年9月在苏州大学附属第二医院神经内科就诊的299例急性缺血性脑卒中患者,根据发病3个月时改良Rankin量表评分分为无残疾组(改良Rankin量表评分≤1,n=207)和残疾组(1<改良Rankin量表评分≤5,n=92),比较两组患者的基线资料、经胸超声心动图与三维斑点追踪超声心动图参数差异,采用多因素二元Logistic回归分析患者残疾的独立危险因素。将与预后不良相关的变量组合建立模型,采用受试者工作曲线评估模型对预后不良的预测效能。根据左室射血分数与患者发病后功能残疾的受试者工作曲线获得最佳界值,将患者分为高左室射血分数组和低左室射血分数组,采用卡方检验比较两组间预后不良率。结果与结论:①与无残疾组相比,残疾组患者左室射血分数更低(P=0.011),两组间入院美国国立卫生研究院脑卒中量表(NIHSS)评分、急性脑卒中Org10172治疗试验(TOAST)分型、牛津郡社区脑卒中计划(OCSP)分型存在显著差异(P<0.05);多因素Logistic回归分析显示,左室射血分数、入院NIHSS评分、OCSP分型与脑卒中发病3个月时残疾独立相关(P<0.05);②将入院NIHSS评分、OCSP分型纳入模型1,模型1加入左室射血分数为模型2,将所有单因素显著差异变量纳入模型3,受试者工作特征曲线分析显示三者预测脑卒中发病3个月时残疾的曲线下面积分别为0.769,0.806,0.824;③根据左室射血分数与发病3个月时残疾的受试者工作特征曲线得到左室射血分数的最佳切点为60.25%BACKGROUND:Transthoracic echocardiography and speckle tracking echocardiography parameters are closely related to stroke occurrence and prognosis.However,the role of transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters in predicting functional disability following acute ischemic stroke remains unclear.OBJECTIVE:To explore the relationship between transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters and functional disability at 3 months post-stroke in patients with acute ischemic stroke.METHODS:A total of 299 patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Soochow University between December 2020 and September 2022 were prospectively enrolled.Patients were divided into no disability(n=207)and disability(n=92)groups based on modified Rankin Scale(mRS)scores(≤1 as no disability;1<mRS score≤5 as disability)at 3 months.Baseline characteristics and transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters were compared between groups.Independent risk factors for disability were identified using multivariate logistic regression.Predictive models were developed by incorporating variables associated with poor prognosis,and their performance was assessed using the receiver operating characteristic curve analysis.The optimal cutoff value for left ventricular ejection fraction was determined from the receiver operating characteristic curve,and patients were stratified into high and low left ventricular ejection fraction groups.Chi-square test was used to compare prognosis rate between two groups.RESULTS AND CONCLUSION:(1)The disability group had significantly lower left ventricular ejection fraction compared with the no disability group(P=0.011).Significant differences in the National Institute of Health Stroke Scale scores,Trial of ORG 10172 in Acute Stroke Treatment,and Oxfordshire Community Stroke Project classifications were observed(P<0.05).Multivariate l

关 键 词：急性缺血性脑卒中 经胸超声心动图 三维斑点追踪超声心动图 预后 残疾 左室射血分数 改良Rankin量表 受试者工作曲线 工程化组织构建 

分 类 号：R445.1[医药卫生—影像医学与核医学] R319[医药卫生—诊断学] R743.33[医药卫生—临床医学]