电磁扰动系数对急性缺血性卒中机械开通术后出血转化的预测作用

Prognostic effect of electromagnetic disturbance coefficient on hemorrhage transformation after mechanical reperfusion of acute ischemic stroke

目的探讨电磁扰动系数对急性缺血性卒中患者机械开通术后发生出血转化的预测作用。方法回顾性连续纳入2018年2月至2019年4月河南省人民医院神经外科重症监护室(85例)及河南省周口市中心医院(43例)、河南省开封市中心医院(38例)、河南省安阳市人民医院(30例)神经外科收治的急性缺血性卒中行机械开通术患者196例,经全脑血管DSA证实为颅底前循环大动脉闭塞。根据机械开通术后是否出现出血转化,将196例患者分为出血转化组(40例)和无出血转化组(156例)。记录两组患者的一般资料,包括性别、年龄、高血压病、冠心病、糖尿病、心房颤动、入院时美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、发病至治疗时间、电磁扰动系数,并进行组间比较。以多因素Logistic回归分析和受试者工作特征(ROC)曲线评估机械开通术后出血转化的影响因素。机械开通术后行电磁扰动系数动态监测,采用24 h持续动态监测1~3 d,此后3次/d,15 min/次,共监测7 d。该研究以术后首次监测值为目标值。电磁扰动系数正常范围为125~145。结果(1)两组患者性别、高血压病、冠心病、糖尿病、年龄、发病至治疗时间的差异均无统计学意义(均P>0.05);出血转化组心房颤动比例大于无出血转化组[27.5%(11/40)比12.8%(20/156)],入院时NIHSS评分[(15.2±2.6)分比(12.4±2.4)分]、电磁扰动系数水平高于无出血转化组[(153±23)比(128±19)],术前ASPECTS水平低于无出血转化组[(6.4±2.3)分比(7.4±1.5)分],组间差异均有统计学意义(均P<0.05)。(2)以急性缺血性卒中机械开通术后发生出血转化为因变量,将心房颤动、入院时NIHSS评分(由低到高)、术前ASPECTS(由低到高)、电磁扰动系数(由小到大)进一步行多因素Logistic回归分析,结果显示,心房颤动(OR=5.070,95%CI:1.800~14.277,P=0.002)、入院时NIHSS评分升高(OR=1.198,95%CI:1.034~1.388,P=0.016)、电磁扰动系数增大(OR=1.061,95%CI:1.038~1.085,P<0.01)是发生出血转化的危险因素,术前ASPECTS升高出血转化的保护因素(OR=0.671,95%CI:0.509~0.883,P=0.016)。(3)ROC曲线下面积以0.5作为参考界值,电磁扰动系数曲线下面积为0.797(P<0.01),电磁扰动系数的最佳预测值为143,其敏感度为67.5%,特异度为78.8%。结论电磁扰动系数升高可尝试用于预测急性缺血性卒中机械开通术后发生出血转化的风险,应结合头部CT检查结果进行明确,为及时调整治疗方案提供参考。

Objective To investigate the prognostic effect of electromagnetic disturbance coefficient on hemorrhagic transformation after mechanical reperfusion of acute ischemic stroke.Methods From February 2018 to April 2019,196 consecutive patients with acute ischemic stroke after mechanical reperfusion and admitted in neurosurgery intensive care unit of Henan Provincial People′s Hospital(85 cases),Zhoukou Central Hospital(43 cases),Kaifeng Central Hospital(38 cases)and Anyang People′s Hospital(30 cases)were enrolled retrospectively.The occlusion of anterior circulation artery was confirmed by DSA.Patients were divided into two groups according to whether there was hemorrhagic transformation after mechanical reperfusion:40 patients in the hemorrhagic transformation group and 156 patients in the non-hemorrhagic transformation group.The general data of the two groups were recorded,including sex,age,hypertension,coronary heart disease,diabetes,atrial fibrillation,the National Institutes of Health Stroke Scale(NIHSS)score at admission,Alberta stroke program early CT score(ASPECTS),time from onset to treatment,and electromagnetic disturbance coefficient.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curve were used to evaluate the influencing factors of hemorrhagic transformation after mechanical reperfusion.The dynamic monitoring of the electromagnetic disturbance coefficient was performed after the mechanical reperfusion.The dynamic monitoring was carried out for 7 days.It was continuous 24 hours/d in the first 3 days and followed by 3 times/d and 15 min/time in the later days.Results(1)There was no significant difference in gender,hypertension,coronary heart disease,diabetes mellitus,age and time from onset to treatment between the two groups(all P>0.05);the ratio of atrial fibrillation(27.5%[11/40]vs.12.8%[20/156]),the NIHSS score at admission([15.2±2.6]vs.[12.4±2.4])and the level of electromagnetic disturbance coefficient([153±23]vs.[128±19])were higher in the hemorrhagic transformation group than that in the non-hemorrhagic transformation group;ASPECTS score before surgery was lower than the non-hemorrhagic transformation group([6.4±2.3]vs.[7.4±1.5]),and the difference between groups was statistically significant(all P<0.05).(2)Taking the hemorrhagic transformation after mechanical reperfusion of acute ischemic stroke as dependent variable,the scores of atrial fibrillation,NIHSS at admission(from low to high),ASPECTS score before operation(from low to high),and electromagnetic disturbance coefficient(from small to large)were further analyzed by logistic regression analysis.The results showed atrial fibrillation(OR=5.070,95%CI 1.800-14.277,P=0.002),higher NIHSS at admission(OR=1.198,95%CI 1.034-1.388,P=0.016)and higher electromagnetic disturbance coefficient(OR=1.061,95%CI 1.038-1.085,P<0.01)were risk factors of hemorrhagic transformation,and higher ASPECTS(OR=0.671,95%CI 0.509-0.883,P=0.016)was a protective factor.(3)Taking the reference boundary value of the area under the ROC curve as 0.5,and the area under the electromagnetic disturbance coefficient curve was 0.797(P<0.01).The optimal prognostic value of electromagnetic disturbance coefficient was 143,with the sensitivity of 67.5%and specificity of 78.8%.Conclusion The coefficient of electromagnetic disturbance can be used to predict hemorrhagic transformation after mechanical reperfusion of acute ischemic stroke and be combined with head CT examination results to provide references for therapy adjustment in time.