侧枝循环水平与急性大脑中动脉水平段闭塞溶栓效果的相关性

Correlation between collateral circulation level and thrombolytic effect on the acute occlusion of horizontal segment of the middle cerebral artery

目的探讨急性大脑中动脉水平段(M1段)闭塞溶栓治疗后血管再通情况,分析侧枝循环水平与溶栓结果的相关性。方法选取2018年1月至2019年1月间于保定市第一中心医院神经内科就诊的80例急性大脑中动脉M1段闭塞的患者为研究对象,根据溶栓结果分为再通组和未通组,比较两组临床资料(年龄、性别、体质量指数、合并症、既往史、用药情况等)、实验室指标(凝血功能、肝功能、血小板、血脂等)以及侧枝循环水平。结果比较再通组tan评分情况显著优于未通组,≥2分者显著高于未通组(χ2=14.088,P <0.01);两组患者合并心房颤动和高血压比较差异有统计学意义(χ^2=4.485、5.209,P <0.05);两组患者发病时间、美国国立卫生研究院卒中量表(NIHSS)评分差异有统计学意义,再通组显著低于未通组(t=2.185、2.304,P<0.05);两组患者血小板计数(PLT)、部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D二聚体(DD)、总胆固醇(TC)、甘油三酯(TG)、C反应蛋白(CRP)、空腹血糖水平间差异无统计学意义(P> 0.05),再通组患者低密度脂蛋白(LDL-C)、尿酸(UA)、糖化血红蛋白水平均显著低于未通组(t=2.472、2.012、2.107,P <0.05)。Logistic回归分析显示高血压、NIHSS评分、LDL-C水平为溶栓效果的危险因素(OR=17.842、1.841、3.977,P <0.01),tan评分≥2分为保护因素(OR=0.048,P <0.01)。tan评分≥2分的患者与tan评分<2分患者的mRS评分间有统计学意义(Z=3.278,P <0.01),其中,tan评分≥2分的患者MRS评分0~2分的比例显著高于tan评分<2分患者,差异有统计学意义(χ^2=10.944,P <0.01)。结论侧枝循环水平与急性大脑中动脉M1段闭塞溶栓效果相关,tan评分可用来预测溶栓再通结局。

Objective To investigate the revascularization after thrombolytic therapy in the acute occlusion of horizontal segment of the middle cerebral artery(M1 segment),and analyze the correlation between collateral circulation level and thrombolytic results.Methods 80 patients with acute middle cerebral artery M1 segment occlusion who were admitted to the department of neurology in Baoding first central hospital from January 2018 to January 2019 were selected as research objects.According to the results of thrombolysis,they were divided into revascularization group and non-revascularization group,and the clinical data(age,sex,body mass index,complications,past medical history,medication,etc.),laboratory tests(coagulation function,liver function,platelet,blood lipid,etc.)and collateral circulation levels of the two groups were compared.Results The tan score of revascularization group was significantly better than non-revascularization group,the population of tan score≥2 was significantly more than that of non-revascularization group(χ~2=14.088,P<0.01).There were statistically significant differences in complications with atrial fibrillation,hypertension between the two groups(χ~2=4.485,5.209,P<0.05).The onset time and NIHSS scores of the revascularization group were statistically significant lower than non-revascularization group(t=2.185,2.304,P<0.05).There were no statistically significant differences in the levels of blood platelet count(PLT),activated partial thromboplastin time(APTT),prothrombin time(PT),D-Dimer(DD),total cholesterol(TC),triglyceride(TG),C-reactive protein(CRP)and fasting blood glucose between the two groups(P>0.05),while the levels of low density lipoprotein cholesterol(LDL-C),uric acid(UA)and glycosylated hemoglobin in the revascularization group were significantly lower than those in the non-revascularization group(t=2.47,2.01,2.11,P<0.05).Logistic regression analysis showed that hypertension,NIHSS score and LDL-C level were risk factors for thrombolytic effect(OR=17.842,1.841,3.977,P<0.01),and tan score≥2 was a protective factor(OR=0.048,P<0.01).There was a statistically significant difference of the mRS scores between the patients with tan score≥2 and patients with tan score<2(Z=3.278,P<0.01).Among them,MRS score of the patients with tan score from 0 to 2 was significantly higher in patients with tan score<2,the difference was statistically significant(χ~2=10.944,P<0.01).Conclusion The level of collateral circulation is correlated with the effect of thrombolysis on acute middle cerebral artery M1 segment occlusion,and tan score can be used to predict thrombolytic revascularization outcome.