区域软脑膜侧支循环评分与Tan侧支循环评分预测前循环缺血性卒中静脉溶栓预后

Comparison of Regional Lepomeningeal Collateral Score and Tan Collateral Score in prediction of prognosis of anterior ischemic stroke with intravenous thrombolysis

目的筛查急性前循环缺血性卒中静脉溶栓预后相关影响因素,并探讨基于CTA的两种侧支循环评价量表对急性前循环缺血性卒中静脉溶栓预后的预测能力。方法连续纳入136例急性缺血性卒中患者,均予重组组织型纤溶酶原激活物静脉溶栓,采用基于CTA的区域软脑膜侧支循环评分(r LMC)和Tan侧支循环评分(Tan)评价侧支循环,发病后3个月采用改良Rankin量表评价预后(以病残或病死为主要结局指标)。单因素和多因素逐步法Logistic回归分析筛查急性前循环缺血性卒中静脉溶栓预后不良相关危险因素,受试者工作特征(ROC)曲线评价Tan评分对急性前循环缺血性卒中静脉溶栓预后的预测能力。结果最终纳入122例行静脉溶栓治疗的急性前循环缺血性卒中患者,Logistic回归分析显示,发病至静脉溶栓时间180~270 min(OR=0.309,95%CI:0.134~0.713;P=0.006)和Tan评分0~1分(OR=7.339,95%CI:2.072~25.994;P=0.002)是急性前循环缺血性卒中静脉溶栓预后不良的独立危险因素。Tan评分预测急性前循环缺血性卒中静脉溶栓预后的ROC曲线显示,曲线下面积为0.753(P=0.021)。结论发病至静脉溶栓时间180~270 min和Tan评分0~1分是急性前循环缺血性卒中静脉溶栓预后不良的独立危险因素。与rLMC评分相比,Tan评分是一种相对简单且预测能力较好的侧支循环评价量表。

Objective To screen the related influencing factors of prognosis in acute anterior ischemic stroke patients who underwent intravenous thrombolysis,and to explore the predictive ability of two collateral scores based on CT angiography（CTA）.MethodsA total of 136 patients with acute ischemic stroke were treated by recombinant tissue-type plasminogen activator（rt-PA）intravenous thrombolysis.Regional Lepomeningeal Collateral Score（rLMC）and Tan Collateral Score（Tan）based on CTA were used to assess the collateral status.Modified Rankin Scale（mRS）was used to evaluate the prognosis（death or disability as main outcome indicators）3 months after onset.Univariate and multivariate stepwise Logistic regression analysis was used to screen related risk factors for poor prognosis of intravenous thrombolysis in acute anterior ischemic stroke.Receiver operating characteristic（ROC）curve was used to evaluate predictive ability of Tan score on the prognosis of intravenous thrombolysis in acute anterior ischemic stroke.ResultsAmong 136 cases,122 patients with acute anterior ischemic stroke who underwent rt-PA intravenous thrombolysis were finally included.Logistic regression analysis showed time from onset to intravenous thrombolysis（180-270 min;OR=0.309,95%CI：0.134-0.713,P=0.006）and Tan（0-1 score;OR=7.339,95%CI：2.072-25.994,P=0.002）was independent risk factors for poor prognosis of intravenous thrombolysis in acute anterior ischemic stroke.ROC curve of Tan score predicting the prognosis of intravenous thrombolysis in acute anterior ischemic stroke indicated that area under the curve（AUC）was 0.753（P=0.021）.ConclusionsTime from onset to intravenous thrombolysis（180-270 min）and Tan score（0-1 score）are independent risk factors for poor prognosis of intravenous thrombolysis in acute anterior ischemic stroke.Compared with rLMC score,Tan score is a simple and reliable collateral status evaluation system.