大脑中动脉闭塞引起的老年急性脑梗死患者预后的影响因素分析

Influencing factors of outcome in elderly patients with acute cerebral infarction due to middle cerebral artery occlusion

目的分析大脑中动脉(MCA)闭塞引起的老年急性脑梗死患者预后的影响因素。方法回顾性纳入MCA闭塞引起的老年急性脑梗死患者127例,治疗3个月后予以改良的Rankin量表(mRS)进行评分,mRS评分≤2分为预后良好组67例(mRS≤2分组),mRS评分>2分为预后不良组60例(mRS>2分组)。单因素分析2组入院时基线及临床资料,将有意义的指标纳入logistic回归模型,通过多因素logistic回归分析、ROC曲线评估MCA闭塞引起的老年急性脑梗死患者预后的影响因素。结果与mRS>2分组比较,mRS≤2分组侧支循环良好比例、弥散加权成像(DWI)、Alberta卒中项目早期CT评分(ASPECTS)、3 d相对神经功能改善率显著增高,心源性脑栓塞比例显著降低(P<0.01)。多因素logistic回归分析提示,DWI-ASPECTS(OR=1.631,95%CI:1.308~2.033,P=0.000)、侧支循环良好(OR=6.328,95%CI:2.164~18.510,P=0.001)是MCA闭塞引起的老年急性脑梗死患者3个月良好预后的独立影响因素。DWI-ASPECTS、侧支循环良好ROC曲线下面积分别为0.853(95%CI:0.788~0.917,P<0.01)、0.796(95%CI:0.714~0.877,P<0.01),且DWI-ASPECTS预测3个月良好预后的最佳临界值为6.5分,敏感性67.2%,特异性86.7%。结论影响MCA闭塞引起的老年急性脑梗死患者3个月预后的因素较多,DWI-ASPECTS、侧支循环可作为脑梗死预后转归的重要评估指标。

Objective To analyze the influencing factors of outcome in elderly patients with ACI due to middle cerebral artery occlusion(MCAO).Methods One hundred and twenty-seven elderly patients with ACI due to MCAO admitted to our hospital from January 2017 to December 2019 were divided into good outcome group or mRS score≤2 group(n=67)and poor outcome group or mRS score>2 group(n=60).Their baseline and clinical data on admission were analyzed by univariate logistic regression analysis.The influencing factors of outcome in elderly patients with ACI due to MCAO were analyzed by multivariate logistic regression analysis and ROC curve analysis respectively.Results The rate of good collateral circulation,DWI-ASPECTS score and recovery rate of 3-day neurological function were significantly higher while that of cardiogenic cerebral embolism was significantly lower in mRS score≤2 group than in mRS score>2 group(P<0.01).Multivariate logistic regression analysis showed that DWI-ASPECTS score and collateral circulation were the influencing factors of good outcome in elderly patients with ACI due to MCAO at month 3 after treatment(OR=1.631,95%CI:1.308-2.033,P=0.000;OR=6.328,95%CI:2.164-8.510,P=0.001).The AUC for DWI-ASPECTS and good collateral circulation in predicting the outcome in elderly patients with ACI due to MCAO was 0.853 and 0.796 respec-tively(95%CI:0.788-0.917,P<0.01;95%CI:0.714-0.877,P<0.01).The optimal cut-off value of DWI-ASPECTS score in predicting the good outcome in elderly patients with ACI due to MCAO was 6.5 at month 3 ofter treatment with a sensitivity of 67.2% and a specificity of 86.7%.Conclusion Many factors can affect the outcome in elderly patients with ACI due to MCAO after 3 months of treatment.DWI-ASPECTS score and collateral circulation can be used as an important index in assessing the good outcome in elderly patients with ACI due to MCAO.