急性缺血性卒中机械取栓术后颅内出血的预测因素分析

Predictors of intracranial hemorrhage after mechanical thrombectomy in acute ischemic stroke

目的探讨急性缺血性卒中患者机械取栓术(mechanical thrombectomy,MT)后发生颅内出血(intracranial hemorrhage,ICH)的预测因素。材料与方法回顾性分析2017年1月至2019年6月在本院就诊的急性缺血性卒中患者135例。所有患者均于MT治疗前接受MRI检查,并于治疗后24 h复查头颅CT或MRI评估患者ICH。将ICH分为症状性颅内出血(symptomatic ICH,sICH)和非sICH(无ICH和无sICH)。记录所有患者的MRI数据及临床资料。统计学方法分析急性缺血性卒中患者MT术后发生ICH、sICH预测因素。结果与无ICH组(79例)相比,ICH组(56例)患者具有较高的空腹血糖水平(129.08±18.87与139.77±16.70)、糖化血红蛋白(HbA1c)(5.57±0.34与5.99±0.42)及DWI梗死体积(20.28±26.30与5.99±0.42),两组间比较有统计学差异(t=-7.974,P<0.001;t=-6.421,P<0.001;t=-2.970,P=0.004)。sICH组(18例)患者DWI梗死体积(52.21±50.23)明显大于非sICH组(117例)(24.28±29.99),差异有统计学意义(t=-3.317;P=0.001)。Spearman相关分析显示空腹血糖(r=0.554;P<0.001)、HbA1c(r=0.450;P<0.001)、DWI梗死体积(r=0.309;P<0.001)与ICH呈正相关;DWI梗死体积(r=0.234;P=0.006)与sICH呈正相关。逻辑回归分析结果显示空腹血糖[OR(95%CI):1.233(1.139~1.335),P<0.001]、HbA1c[OR(95%CI):39.121(7.537~203.052),P<0.001]、DWI梗死体积[OR(95%CI):1.025(1.006~1.044),P=0.009]为预测卒中MT术后发生ICH的独立预测因子;DWI梗死体积[OR(95%CI):1.018(1.006~1.030),P=0.004]为预测卒中MT术后发生sICH的独立预测因子。结论综合评估空腹血糖、HbA1c、DWI梗死体积可以有效地预测急性缺血性卒中患者MT术后ICH、sICH的发生,可指导临床个性化治疗、改善预后。

Objective:To investigate the predictors for the occurrence of intracranial hemorrhage(ICH)in acute ischemic stroke patients after mechanical thrombectomy(MT).Materials and Methods:In this retrospective study,one hundred and thirty-five acute stroke patients who were treated in our hospital from January 2017 to June 2019 were evaluated.All patients underwent MR examination after MT therapy.ICH was evaluated by brain CT or MR examination after MT within 24 hours.ICH was divided into symptomatic ICH(sICH)and non-sICH(patients without ICH and sICH).MRI data and other clinical data were recorded.Statistical methods were used to analyze the predictors of ICH and sICH after MT in acute ischemic stroke.Results:Compared with no ICH group(n=79),ICH group(n=56)had higher fasting blood glucose(129.08±18.87 vs 139.77±16.70),higher glycated hemoglobin(HbA1c)(5.57±0.34 vs 5.99±0.42)and larger DWI infarct volume(20.28±26.30 vs 5.99±0.42),there were significant differences between two groups(t=-7.974,P<0.001;t=-6.421,P<0.001;t=-2.970,P=0.004).The DWI infarct volume in sICH group(n=18)(52.21±50.23)was larger than that in non-sICH(n=117)(24.28±29.99),the difference was statistically significant(t=-3.317;P=0.001).Spearman correlation analysis showed that fasting blood glucose(r=0.554;P<0.001),HbA1c(r=0.450;P<0.001)and larger DWI infarct volume(r=0.309;P<0.001)were positively correlated with ICH,DWI infarct volume(r=0.234;P=0.006)was positively correlated with sICH.Logistic regression analysis showed that fasting blood glucose[OR(95%CI):1.233(1.139─1.335),P<0.001],HbA1c[OR(95%CI):39.121(7.537─203.052),P<0.001]and larger DWI infarct volume[OR(95%CI):1.025(1.006─1.044),P=0.009]were independent predictors of ICH after MT;DWI infarct volume[OR(95%CI):1.018(1.006─1.030),P=0.004]were independent predictors of sICH after MT.Conclusions:Comprehensive evaluation of fasting blood glucose,HbA1c and DWI infarct volume can effectively predict the occurrence of ICH and sICH after MT,and guide clinical individualized treatment and improve functional outcome.