SPAN对行早期血管内治疗的前循环急性大血管闭塞性卒中患者临床预后的评估价值

Evaluation value of SPAN for clinical outcome of acute ischemic stroke patients with anterior circulation large vessel occlusion after early endovascular treatment

目的探讨卒中患者预后指数(SPAN)对早期血管内治疗前循环急性大血管闭塞性卒中(ALVOS)患者临床预后的评估价值。方法收集2018年1月至2020年6月在晋中市第一医院就诊并行早期血管内治疗的ALVOS患者138例,根据术后90d改良Rankin量表(mRS)分为预后良好组(mRS≤2分,n=63)和预后不良组(mRS>2分,n=75)。比较分析两组的一般临床资料及美国介入与治疗神经放射学学会/介入放射学学会(ASITN/SIR)、改良脑梗死溶栓(mTICI)分级、SPAN评分,多因素Logistic回归分析预后影响因素,绘制受试者操作特征(ROC)曲线分析SPAN对预后的预测价值。结果预后良好组与预后不良组年龄、BMI、心房颤动史、基线收缩压(SBP)、TOAST分型、基线NIHSS评分、ASPECTS评分、病变部位及侧支循环状态比较,差异有统计学意义(^(均)P<0.05);预后良好组与预后不良组的发病至血管再通时间、机械取栓次数、颅内出血转化分级、再通成功率、SPAN均值及SPAN≥100率比较,差异有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=1.175,95%CI:1.023~1.521)、基础NIHSS评分(OR=1.163,95%CI:1.012~1.341)、侧支循环(OR=0.221,95%CI:0.075~0.652)、mTICI分级(OR=0.458,95%CI:0.133~0.626)和SPAN(OR=3.843,95%CI:1.332~5.271)是血管内治疗ALVOS预后的预测因素。ROC曲线分析显示,SPAN截断值为90分时,对预后不良的预测敏感性、准确性分别为76.92%、92.31%,曲线下面积(AUC)为0.867(95%CI:0.676~0.967)。结论SPAN与ALVOS患者早期血管内治疗预后密切相关,可作为预后预测的参考指标。

Objective To evaluate the evaluation value of stroke prognostication using age and National Institute of Health Stroke Scale index(SPAN)for clinical outcome of acute ischemic stroke patients with anterior circulation large vessel occlusion(ALVOS)after early endovascular treatment.Methods 138 ALVOS patients who underwent early endovascular treatment in Jinzhong First People’s Hospital from January 2017 to June 2019 were divided into two groups according to the modified Rankin Scale(mRS)at 90 days after surgery:mRS≤2 as favorable outcome group(n=63),mRS>2 as adverse outcome group(n=75).The general clinical data,the American Society of Interventional and Therapeutic Neuroradiology/Societty Interventional Radiolog(ASITN/SIR),the Modified Cerebral Infarction Thrombolytic(mTICI)classification,SPAN Score were compared between the two groups,the Multi-factor Logistic regression analysis was used to analyze the prognostic factors,and the receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of SPAN on the prognosis.Results The age,atrial fibrillation history,baseline systolic blood pressure(SBP),TOAST classification,baseline NIHSS score,ASPECTS score,lesion site and collateral circulation status were significantly different between the favorable outcome group and adverse outcome group(P<0.05);there were statistically significant differences of time from onset to vascular recanalization,number of mechanical thrombectomy,grade of conversion of intracranial hemorrhage,success rate of recanalization,mean SPAN and SPAN≥100 rate(P<0.05).Multivariate Logistic regression analysis showed that age(OR=1.175,95%CI:1.023-1.521),basic NIHSS score(OR=1.163,95%CI:1.012-1.341),collateral circulation(OR=0.221,95%Cl:0.075-0.652),mTICI classification(OR=0.458,95%Cl:0.133-0.626),and SPAN(OR=3.843,95%CI:1.332-5.271)were predictors of prognosis for endovascular treatment of ALVOS.The ROC curve analysis showed that when the SPAN cutoff value was90 points,the prediction sensitivity and accuracy for adverse prognosis were 76.92%and 92.31%,respectively,and the area under the curve(AUC)was 0.867(95%Cl 0.676-0.967).Conclusion SPAN is closely related to the prognosis of patients with ALVOS after early endovascular treatment,which an be used as a reference index for prognosis prediction.