毛细血管指数评分与前循环急性缺血性卒中血管内治疗转归的相关性

Correlation between capillary index score and outcome of endovascular treatment for acute anterior circulation ischemic stroke

目的 探讨毛细血管指数评分（capilary index score,CIS）与前循环急性缺血性卒中（acute ischemic stroke,AIS）患者血管内治疗后临床转归的相关性.方法 回顾性纳入2014年3月至2017年3月在南京军区南京总医院和芜湖弋矶山医院接受血管内治疗的前循环AIS患者.收集术中数字减影血管造影资料并计算CIS,分为CIS组不良组（0～1分）和CIS良好组（2～3分）.应用单变量分析比较2组间基线资料、临床资料和转归;采用多变量logistic回归分析确定CIS与血管内治疗后有症状脑出血（symptomatic intracerebral hemorrhage,sICH）、死亡以及90 d时功能转归（改良Rankin量表评分0～2分定义为转归良好）的相关性.结果 总共纳入157例患者,其中91例（58.0％）CIS不良,66例（42.0％）CIS良好.CIS不良组年龄（P=0.020）、基线收缩压（P=0.014）、基线美国国立卫生研究院卒中量表评分（P〈0.001）、空腹血糖水平（P=0.011）、早期梗死范围（P〈0.001）以及颈内动脉闭塞（P〈0.001）和取栓〉3次（P=0.042）的患者比例显著高于CIS良好组.CIS良好组血管成功再通率（P〈0.001）和90 d时转归良好率（P〈0.001）显著高于CIS不良组,而sICH发生率（P=0.002）和病死率（P〈0.001）显著低于CIS不良组.多变量logistic回归分析显示,CIS与前循环AIS患者血管内治疗后90 d时功能转归[优势比（odd ratio,OR）0.581,95％可信区间（confidence interval,CI）0.419～0.805;P=0.001]和72 h内sICH风险（OR 0.611,95％CI 0.407～0.919;P=0.018）显著相关,但与死亡风险无显著相关性（OR 0.783,95％CI 0.492～1.246;P=0.301）.结论 CIS与前循环AIS患者血管内治疗后临床转归显著相关,可作为选择血管内治疗患者的一种工具.

Objective To investigate the capillary index score （CIS） and clinical outcome after endovascular treatment in patients with anterior circulation acute ischemic stroke （AIS）. Methods From March 2014 to March 2017,patients with anterior circulation AIS received endovascular treatment in Jinling Hospital and Wuhu Yijishan Hospital were enrolled retrospectively. The data of intraoperative digital subtraction angiography were collected and CIS was calculated. They were divided into either a poor CIS group （score 0-1） or a good CIS group （scores 2-3）. Univariate analysis was used to compare the baseline data, clinical data, and outcomes between the 2 groups. Multivariate logistic regression analysis was used to determine the correlation between CIS and symptomatic intracerebral hemorrhage （sICH）, death, and functional outcome at 90 d after endovascular treatment（modified Rankin Scale score 0 to 2 was defined as good outcome）. Results A total of 157 patients were enrolled, including 91 （58.0%） had poor CIS and 66 （42.0%） had good CIS.Age（P=0.020）,baseline systolic pressure（P=0.014）,baseline National Institutes of Health Stroke Scale score （P=0.011）, early infarct size （P〈0.001）, as well as the proportions of internal carotid artery occlusion（P〈0.001）and embolectomy 〉3 times（P=0.042）of the poor CIS group were significantly higher than those of the good CIS group.The vascular successful recanalization rate（P〈0.001） and good outcome rate （P〈0.001） at 90 d in the good CIS group were significantly higher than those in the poor CIS group, while the incidence of sICH （P=0.002） and mortality （P〈0.001） were significantly lower than those of the poor CIS group. Multivariate logistic regression analysis showed that CIS were significantly correlated with the functional outcome at 90 d （odd ratio [OR] 0.581, 95% confidence interval[CI]0.419-0.805;P=0.001）and the risk of sICH at 72 h（OR 0.611,95% CI 0.407-0.919; P=0.018） after endovascular treatment in patients with anterior circulation AIS,but it did not have a significant correlation with the risk of death （OR 0.783, 95% CI 0.492-1.246; P=0.301）. Conclusions CIS was significantly correlated with the clinical outcome in patients with anterior circulation AIS after endovascular treatment. It can be used as a tool to select patients for endovascular treatment.