脑侧支循环对急性脑梗死患者机械取栓后的影响

Effect of collateral circulation on mechanical thrombectomy in patients with acute cerebral infarction

目的探讨脑侧支循环对急性脑梗死患者Solitaire AB支架机械取栓后短期预后的影响及其影响因素分析。方法回顾性分析2017-03—2019-02安阳地区医院收治的急性脑梗死患者200例,根据全脑血管造影术将患者分成有侧支循环组(n=131)和无侧支循环组(n=69)。比较2组患者预后情况,单因素分析2组患者基线资料,对差异有统计学意义的单因素行非条件Logistic多因素回归分析,探究脑侧支循环建立的影响因素并建立其预测模型。结果术后24 h和术后30 d 2组患者美国国立卫生院神经功能缺损(NIHSS)评分与入院时相比明显降低(P<0.05),且侧支循环组患者在术后30 d的NIHSS评分与无侧支循环组相比明显降低(P<0.05);侧支循环组患者入院时血清HIF-1α和VEGF水平与无侧支循环组相比明显上调(P<0.05);2组患者在年龄、吸烟史、暂时性缺血发作史、低密度脂蛋白胆固醇、同型半胱氨酸、脑血管狭窄程度、高血压、狭窄血管数量和循环病变部位等差异有统计学意义(P<0.05),而在性别、糖尿病、肥胖、总胆固醇、高密度脂蛋白胆固醇、饮酒、甘油三酯、葡萄糖、尿酸、血小板、血浆纤维蛋白原、白细胞和冠心病等差异无统计学意义(P>0.05);以基线资料单因素分析中差异有统计学意义的8项指标为自变量,以是否建立侧支循环(赋值建立=1,不建立=0)为因变量,进行非条件Logistic回归分析。Logistic回归分析表明高龄(OR=1.260,95%CI 0.149~10.649)、吸烟史(OR=1.718,95%CI 0.081~36.619)、前循环病变(OR=1.259,95%CI 0.918~1.726)、同型半胱氨酸(OR=1.024,95%CI 1.006~1.043)、高血压(OR=2.010,95%CI 1.161~3.479)、低密度脂蛋白胆固醇(OR=0.722,95%CI 0.530~0.984)、HIF-1α(OR=2.664,95%CI 0.729~9.733)和VEGF(OR=1.225,95%CI 0.371~4.042)等8项指标差异具有统计学意义(P<0.05)。得到Logistic回归模型logit(P)=logit(P)=-4.109+0.231×1+0.541×2+0.230×3+0.024×4+0.698×5-0.326×6+0.980×7+0.203×8,其中X1代表年龄,X2代表吸烟史,X3代表前循环病变,X4代表同型半胱氨酸,X5代表高血压,X6代表低密度脂蛋白胆固醇,X7代表HIF-1α和X8代表VEGF。结论Solitaire AB支架机械取栓可有效修复患者神经功能损伤,改善短期预后。脑侧支循环建立影响因素较多,高血压、高龄、吸烟史和高同型半胱氨酸是急性脑梗死患者侧支循环建立的危险因素,低密度脂蛋白胆固醇、前循环病变、血清HIF-1α和VEGF可有效促进脑侧支循环建立。

Objective To study the effect of cerebral collateral circulation on short-term prognosis after mechanical thrombectomy of Solitaire AB stent in patients with acute cerebral infarction and its influencing factors.Methods 200 cases of acute cerebral infarction patients from March 2017 to February 2019 in our hospital were retrospectively analyzed.The patients were divided into collateral circulation group(131 cases)and non-collateral circulation group(69 cases)depending on the result of DSA.The prognosis in the two groups was analyzed.The basic information and treatment of two groups were compared for single factor analysis,and the significantly different single factor were analyzed by non-conditional Logistic regression analysis,the dangerous factors for establishment of cerebral collateral circulation were established to determine its predictive value.Results After postoperative 24h and 30d,the NIHSS score of the two groups was significantly lower than that of entering hospital(P<0.05),and the NIHSS score of postoperative 30d in the collateral circulation group was significantly lower than that of the non-collateral circulation group(P<0.05);the level of serum HIF-1αand VEGF in in the collateral circulation group was significantly higher than that of non-collateral circulation group(P<0.05).Two groups showed significant difference on age,smoking history,transient ischemic attack history,LDL cholesterol,homocysteine,cerebral vascular stenosis,hypertension,stenosis and circulatory lesions;two groups showed no significant difference on gender,diabetes,obesity,total cholesterol,HDL cholesterol,alcohol consumption,triglycerides,glucose,uric acid,platelets,plasma fibrinogen,white blood cells and coronary heart disease.Logistic regression analysis showed that advanced age(OR=1.260,95%CI 0.149-10.649),smoking history(OR=1.718,95%CI 0.081-36.619),anterior circulation lesions(OR=1.259,95%CI 0.918-1.726),homocysteine(OR=1.024,95%CI 1.006-1.043),hypertension(OR=2.010,95%CI 1.161-3.479),low density lipoprotein cholesterol(OR=0.722,95%CI 0.530-0.984),HIF-1α(OR=2.664,95%CI 0.729-9.733)and VEGF(OR=1.225,95%CI 0.371-4.042)had significant statistical significance.The Logistic regression modellogit(P)=-4.109+0.231×1+0.541×2+0.230×3+0.024×4+0.698×5-0.326×6+0.980×7+0.203×8,of which X1 represents age,X2 represents smoking history,X3 represents anterior circulation lesion,X4 represents homocysteine,X5 represents hypertension,X6 represents low density lipoprotein cholesterol,X7 represents HIF-1αand X8 represents VEGF.Conclusion Solitaire AB stent mechanical thrombolysis can effectively repair nerve function injury and improve short-term prognosis in patients.There are many influencing factors in the establishment of l collateral circulation,high blood pressure,old age,smoking history and homocysteine are the risk factors for the establishment of collateral circulation in patients with acute cerebral infarction,and low density lipoprotein cholesterol,anterior circulation lesions,serum HIF-1αand VEGF can effectively promote the establishment of cerebral collateral circulation.