大脑中动脉狭窄的急性缺血性脑卒中患者静脉溶栓后侧支循环代偿的多因素分析

Risk factors for leptomeningeal collateral circulation compensation in patients with AIS due to MCA stenosis after thrombolytic therapy

目的探讨大脑中动脉狭窄的急性缺血性脑卒中患者静脉溶栓后软脑膜侧支循环代偿的相关因素。方法收集大脑中动脉狭窄的急性缺血性脑卒中患者178例,给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓。根据溶栓后区域软脑膜评分(rLMC)分为代偿较差组65例(rLMC 0~10分),代偿较好组113例(rLMC 11~20分)。采集患者临床基线数据,头颈CT血管造影评估软脑膜侧支循环。采用美国国立卫生研究院卒中量表(NIHSS)评分和改良的Rankin量表(mRS)评分。结果代偿较好组高血压、溶栓后24hNIHSS及10dNIHSS评分、90d mRS评分、颅内出血及死亡比例明显低于代偿较差组,TG、预后良好比例明显高于代偿较差组(P<0.05,P<0.01)。多因素logistic回归分析显示,高血压(OR=2.831,95%CI:1.100~7.287,P=0.031)、TG(OR=2.136,95%CI:1.026~4.448,P=0.034)及陈旧性脑梗死(OR=2.922,95%CI:1.096~7.789,P=0.032)与静脉溶栓治疗急性脑卒中后侧支循环代偿相关。结论高血压不利于大脑中动脉狭窄的急性缺血性脑卒中患者溶栓后侧支循环的建立,而TG有助于软脑膜侧支的增长。陈旧性脑梗死是软脑膜侧支循环代偿不良的独立预测因子。

Objective To study the risk factors for leptomeningeal collateral circulation（LMA）compensation in patients with acute ischemic stroke（AIS）due to middle cerebral artery（MCA）stenosis after thrombolytic therapy.Methods The LMA compensation was assessed by craniocervical CTA in 178 patients with AIS due to MCA stenosis after they underwent thrombolytic therapy with rt-PA.The patients were divided into poor LMA group（n=65）and good LMA group（n=113）according to their regional leptomeningeal score.Results The incidence of hypertension,the NIHSS score after 24 hand 10days of thrombolytic therapy,the mRS score,the incidence of intracranial hemorrhage and mortality were significantly lower,the serum TG level and the outcome were significantly better in good LMA group than in poor LMA group after 90 days of thrombolytic therapy（P〈0.05,P〈0.01）.Multivariate logistic regression analysis showed that hypertension,serum TG level,and old ischemic stroke were related with LMA compensation in AIS patients after thrombolytic therapy（OR=2.831,95%CI：1.100-7.287,P=0.031;OR=2.136,95%CI：1.026-4.448,P=0.034;OR=2.922,95%CI：1.096-7.789,P=0.032）.Conclusion Hypertension does not help to establish LMA while serum TG level contributes to the growth of LMA in AIS patients due to MCA stenosis after thrombolytic therapy.Old ischemic stroke is an independent predictor for the poor LMA compensation.