基底动脉闭塞CTA半定量评分与临床预后相关性评估

Evaluation of correlation between semiquantitative score on CTA for basilar artery occlusion and clinical outcome

目的:初步探讨基于CT血管造影(CTA)原始图像的基底动脉闭塞(BAO)半定量评分(BATMAN评分)与接受血管内治疗的急性BAO患者临床预后相关性。方法:收集我院58例2015年1月-2018年4月经CTA检查证实为BAO的后循环缺血性卒中患者临床及影像学资料。根据90天改良Rankin量表(mRS)将BAO患者分为预后良好组及预后不良组,比较两组间的BATMAN评分及临床资料。将差异具有统计学意义(P<0.05)的影响因素为自变量,以预后为因变量进行多因素二元Logistic回归分析,并对其存在统计学意义的变量进行ROC曲线分析。结果:预后良好组与预后不良组临床及影像分析结果显示入院时昏迷、入院基线美国国立卫生研究院卒中量表(NIHSS)评分及BATMAN评分差异显著,具有统计学意义(P<0.05),而性别、年龄、血管危险因素统计学无显著差异性(P>0.05)。多因素二元Logistic回归分析结果显示入院基线NIHSS评分、BATMAN评分与BAO患者预后独立相关(P<0.05,NIHSS评分(OR 1.310,95%CI 1.072~1.600),BATMAN评分(OR 0.449,95%CI 0.255~0.792)),而入院时昏迷的相关性不再显著(P>0.05)。ROC曲线分析结果提示BATMAN评分预测BAO患者预后良好的最佳分割点为6时,敏感度为92.31%,特异度71.87%,ROC曲线下面积为0.843(P<0.05)。结论:BATMAN评分可作为急性BAO患者临床预后相关性的影像学指标。

Objective: To investigate the correlation between semiquantitative scores of basilar artery occlusion(BAO) based on CTA original images(BATMAN score) and clinical prognosis of patients with BAO receiving endovascular treatment. Methods: We studied the clinical and imaging data of 58 consecutive patients presenting to our hospital from January 2015 to April 2018 with acute BAO of posterior circulation ischemic stroke confirmed by CTA. According to mRS score, the patients were divided into good and poor outcome groups, and BATMAN scores and clinical data were compared between groups. Mul-tivariate binary logistic regression analysis was performed by using the variables with statistical significance in univariate anal-ysis as independent variables, and prognosis as the dependent variable. The variables with statistical significance in regression analysis were included in the receiver operator characteristic(ROC) curve analysis. Results: Univariate analysis showed that coma, NIHSS score and BATMAN score were statistically significant(P<0.05) between groups, while gender, age, stroke risk factors of BAO patients were not statistically significant(P>0.05). After analysis of logistic regression NIHSS score(OR 1.310,95%CI 1.072~1.600) and BATMAN score(OR 0.449, 95%CI 0.255~0.792) were independent predictors of prognosis of BAO patients, and coma was not an independent predictor. ROC analysis indicated that the optimal cut-off point for BATMAN score to predict good prognosis of BAO patients was>6, the sensitivity was 92.31%, the specificity was 71.87%, and the area under the ROC curve was 0.843(P<0.05). Conclusion: The BATMAN score can be used as an imaging index of clinical prognosis in patients with BAO.