侧支循环状态与再灌注治疗预后的关系及CTA侧支循环评分的预测价值

Relationship between the state of collateral circulation and prognosis of patients with acute ischemic stroke after reperfusion therapy and predictive value of CTA collateral circulation scales

目的探讨急性缺血性卒中患者基线侧支循环状态与再灌注治疗预后的关系,并比较阿尔伯特早期卒中计划评分(ASPECTS)、多期CTA评分(mCTAs)和软脑膜侧支评分(rLMCs)的预测价值。方法收集87例接受再灌注治疗的急性缺血性卒中患者的临床资料。采用ASPECTS、mCTAs和rLMCs评分评定基线侧支循环情况。根据90 d mRS评分,将患者分为预后良好组(≤2分)和预后不良组(>2分)。通过单因素及二元Logistic回归分析影响患者预后的独立因素,通过秩相关系数分析三种评分与预后的相关性,并采取ROC曲线比较三种评分的预测价值及截点值。结果与预后良好组比较,预后不良组血糖、总胆固醇、低密度脂蛋白水平及基线mRS评分、治疗前及24 h NIHSS评分、ASPECTS评分、mCTAs评分、rLMCs评分差异有统计学意义(P<0.05~0.01)。Logistic回归分析显示,影响预后不良的变量包括基线mRS(OR=4.786,95%CI:1.449~15.803,P=0.010)、基线NIHSS(OR=1.245,95%CI:1.058~1.466,P=0.008)及rLMCs评分(OR=0.523,95%CI:0.378~0.723,P<0.001)。Spearman相关分析显示,ASPECTS、mCTAs、rLMCs评分与90 d mRS呈负相关(rs=-0.418,rs=-0.611,rs=-0.648;P<0.01)。ROC曲线分析显示,ASPECTS评分、mCTAs评分和rLMCs评分AUC分别为0.706、0.812和0.878,三种评分最佳截点值依次为7.5、2.5和10.5。结论基线侧支循环状态是急性缺血性卒中患者再灌注治疗的独立保护性因素。rLMCs对再灌注治疗预后的预测价值更高,rLMCs≥11分的患者预后更佳。

Objective To explore the relationship between the state of collateral circulation and prognosis of patients with acute ischemic stroke after reperfusion therapy, and compared the predictive value of Alberta stroke program early CT score(ASPECTS), multiphase CTA score(mCTAs) and regional leptomeningeal score(rLMCs). Methods The clinical data of 87 acute ischemic stroke patients treated by reperfusion treatment were collected. The baseline state of collateral circulation was evaluated by ASPECTS, mCTAs and rLMCs. According to 90 d mRS score, patients were divided into favorable(90 d mRS≤2) and unfavorable(90 d mRS>2) outcome groups. Univariate comparison and binary Logistic regression were performed to analyze the effect of independent variables on prognosis, Spearman correlation analysis was used to analyze the correlations between three scales and prognosis, the predictive value and cut-off points of three methods were compared by ROC curve. Results Compared with those in the favorable outcome group, the levels of blood sugar, total cholesterol, low-density lipoprotein and baseline mRS score, NIHSS score before and 24 h after treatment, ASPECTS score, mCTAs score, rLMCs score of unfavorable outcome group had statistical significance(P<0.05-0.01). Logistic regression showed that influencing factors of poor outcome were baseline mRS(OR=4.786, 95%CI: 1.449-15.803, P=0.010), baseline NIHSS(OR=1.245, 95%CI: 1.058-1.466, P=0.008) and rLMCs(OR=0.523, 95%CI: 0.378-0.723, P<0.001). Spearman correlation analysis showed that ASPECTS, mCTAs and rLMCs were negatively correlated with 90 d mRS(rs=-0.418, rs=-0.611, rs=-0.648;P<0.01). The areas under ROC curve of ASPECTS, mCTAs and rLMCs were 0.706, 0.812 and 0.878, and the cut-off points of them were 7.5, 2.5, 10.5 respectively. Conclusions Baseline state of collateral circulation is an independent protective factor of acute ischemic stroke patients with reperfusion therapy. r LMCs has a higher predictive value of reperfusion outcomes,the patient whose r LMCs≥11 may have a better outcome.