NIHSS评分联合DSA检查对急性缺血性卒中患者侧支循环及静脉溶栓治疗预后的评估价值

Value of NIHSS score combined with DSA in evaluating the prognosis of intravenous thrombolysis therapy and the collateral circulation in acute ischemic stroke patients

目的探讨NIHSS评分联合DSA检查对急性缺血性卒中(AIS)患者侧支循环及静脉溶栓治疗预后的评估价值。方法回顾性分析2015年1月至2017年1月在本院接受静脉溶栓治疗后行DSA血管评估的85例AIS患者的临床资料。结果根据DSA检查结果将其分为大血管闭塞组(47例)与非大血管闭塞组(38例)。两组间一般资料的比较差异无统计学意义(均P> 0. 05)。与治疗前比较,大血管闭塞组治疗后1周及1个月时NIHSS评分明显降低,非大血管闭塞组治疗后1 d、1周及1个月时NIHSS评分明显降低(均P <0. 05)。非大血管闭塞组患者治疗前及治疗后各时间点NIHSS评分均明显低于大血管闭塞组(均P <0. 05)。与治疗前比较,两组患者治疗后3个月、6个月时改良Rankin量表(mRS)评分明显降低(均P <0. 05)。非大血管闭塞组患者治疗后各时间点mRS评分均明显低于大血管闭塞组(均P <0. 05)。大血管闭塞组患者侧支循环代偿程度[(1. 87±0. 37)级]明显低于非大血管闭塞组[(2. 92±0. 55)级](t=3. 641,P <0. 05)。溶栓治疗后mRS评分与侧支循环代偿程度呈负相关(r=-0. 792,P <0. 05)。多因素Logistic回归分析结果显示,NIHSS评分子项目中意识水平(OR=1. 626,95%CI:1. 325～2. 128,P=0. 017)、意识水平提问(OR=1. 453,95%CI:1. 102～1. 948,P=0. 001)、凝视(OR=1. 257,95%CI:1. 034～1. 627,P=0. 006)为AIS患者大血管闭塞的独立危险因素。结论经DSA检查后发现侧支循环情况较好AIS患者静脉溶栓治疗后预后较好,其中非大血管闭塞AIS患者疗效更好,且NIHSS评分子项目中的意识水平、意识水平提问以及凝视是对大血管闭塞进行评估的独立危险因素。

Objective To observe the value of NIHSS score combined with DSA in evaluating the prognosis of intravenous thrombolysis therapy and the collateral circulation in acute ischemic stroke （AIS） patients. Methods The clinical data of 85 A1S patients treated with intravenous thrombolysis and DSA vascular evaluation in our hospital from Jan 2015 to Jan 2017 were retrospectively analyzed. Results According to the results of DSA examination were divided into large vessel occlusion group （47 cases） and non large vessel occlusion group （38 cases）. There was no significant difference in general data between the two groups （P 〉 0. 05 ）. Compared with before treatment, the NIHSS score were significantly reduced after treatment 1 week and 1 month of the large vascular occlusion group, the NIHSS score were significantly reduced after treatment 1 d, 1 week and 1 month of the non large vascular occlusion group （ all P 〈 0.05 ）. The NIHSS scores of the non large vessel occlusion group were significantly lower than the large vessel occlusion group each time point before and after treatment （all P 〈 0. 05 ）. Compared with before treatment, the mRS scores of the two groups decreased significantly after treatment 3 months and 6 months （ all P 〈 0. 05 ）. The mRS scores of the non large vessel occlusion group were significantly lower than the large vessel occlusion group each time point before and after treatment （ all P 〈 0. 05 ）. The collateral circulation compensatory degree of the large vessel occlusion group [ （ 1.87 ± 0.37） grade] was significantly lower than the non large vessel occlusion group [ （2.92 ±0.55） gradcl （t =3. 641 ,P 〈0. 05）. After thrombolytie therapy, the mRS score was negatively correlated with the collateral circulation compensatory degree （ r = - 0. 792, P 〈 0. 05 ）. The results of muhiple factor Logistic regression analysis showed that consciousness level （OR = 1. 626, 95% CI： 1. 325 -2. 128, P = 0. 017） , conscious-nesslevelquestioning （OR = 1.453, 95%CI： 1, 102- 1.948, P=0.001） and gaze （OR= 1.257, 95%CI： 1. 034 - 1. 627, P = 0. 006） were independent risk factors for AIS patients with vascular occlusion. Conclusion After DSA examination found that the prognosis of AIS patients with good collateral circulation is better after intravenous thrombolysis, the AIS patients with non large vascular occlusion have better curative effect, and the independent risk factors for the assessment of large vessel occlusion were the level of consciousness, consciousness questioning and gazein the NIHSS scoring program.