老年急性缺血性卒中患者脑梗死增长速率的影响因素及对预后的影响

Risk factor of the growth rate of cerebral infarction and its effects on the prognosis in elderly patients with acute ischemic stroke

目的探究行血管内治疗(EVT)的老年急性缺血性卒中(AIS)患者梗死增长速率的影响因素及其对预后的影响.方法回顾性分析2016年6月至2020年10月于我院行EVT的老年AIS患者,根据患者的预后,获得梗死增长速率的截断值,并据此将患者分为梗死快速增长组及梗死缓慢增长组,通过单因素及多因素分析梗死快速增长的预测因子;基于改良Rankin量表(mRS)评分将患者分为预后良好组(mRS评分0~2分)及预后不良组(mRS评分3~6分),分析患者预后不良的预测因子.结果共纳入67例老年前循环AIS患者,患者65~96岁,平均(78.8±7.6)岁.(1)通过ROC曲线获得预后良好及预后不良患者梗死增长速率的最佳截断值为8.89 ml/h,并据此将患者分为梗死快速增长组(26例)及梗死缓慢增长组(41例).(2)多因素Logistic回归显示,仅不良侧支循环是梗死核心快速增长的独立预测因子(OR=0.162,95%CI:0.053~0.489).(3)较快的梗死增长速率(OR=1.173,95%CI:1.044~1.318)及高美国国立卫生研究院卒中量表(NIHSS)评分(OR=1.146,95%CI:1.018~1.291)是患者90 d时预后不良的预测因子.结论老年AIS患者的侧支循环状态是梗死增长速率的主要影响因素,且较快的梗死增长速率是预后不良的预测因子.

Objective To investigate the risk factors of infarct growth rate of elderly acute ischemic stroke(AIS)patients with endovascular treatment(EVT)and its influence on prognosis.Methods Elderly AIS patients who underwent EVT at Beijing hospital from June 2016 to October 2020 were retrospectively included.Infarct growth rate(ml/h)=infarct core volume(ml)/time from stroke onset to CTP examination(h).Based on the rate of infarct growth and the patient's clinical severity,ROC curve was established*and the cut-off value of the ROC curve was obtained.By the cutoff value of the rate of infarct growth,the patients were divided into cerebral infarct slow-growth group and rapid-growth group.Predictors of rapid growth in infarct were analyzed by univariate and multivariate analysis.The patients were divided into good prog nosis group(mRS score 0-2)and poor prognosis group(mRS score 3-6)according to the mRS score at the day 90 and the predictors of poor prog nosis were analyzed separately.Results A total of 67 elderly AIS patients were included with age ranging from 65-96 years and an average of(78.8±7.6)years.(1)The cut-off value of the optimal infarct growth rate for patients with good and poor prognosis was 8.89 ml/h.The patients were divided into fast-growth group(26 patients)a nd slow-growth group(41 patie nts)according the cut-off value.(2)Multivariate logistic regression showed that only poor collateral circulation was an independent predictor for fast infarct growth(OR=0.162«95%CI:0.053-0.489).(3)Faster infarct growth rate(OR=l.173,95%CZ:1.044-1.318)and high NIHSS score(OR=1.146,95%CI:1.018-1.291)were predictors of poor prognosis.Conclusions Collateral circulation status is a major influencing factor for the infarct growth rate,and a faster infarct growth rate is a predictor of poor prognosis for elderly AIS patients after endovascular treatment.