血栓负荷评分在急性缺血性脑卒中机械取栓治疗中的应用研究

Application Study of Clot Burden Score in Mechanical Thrombectomy for Acute Ischemic Stroke

目的探讨血栓负荷评分(CBS)和机械取栓治疗前循环大血管闭塞的急性缺血性脑卒中(AIS)患者继发出血转化(HT)以及90 d预后的关系。方法收集2020年1~8月收治的86例行机械取栓术的前循环AIS患者的临床资料。根据欧洲急性脑卒中协作研究(ECASS)Ⅱ标准,将患者分为HT组(30例)和无HT(NHT)组(56例);根据术后是否发生实质性血肿(PH)分为PH组(11例)和无PH(NPH)组(75例);根据预后情况将患者分为预后良好组(43例,mRS≤2分)和预后不良组(43例,3分≤mRS≤6分),分别比较两组患者临床资料。结果HT组和NHT组比较,高血压病患病率更高、入院至股动脉穿刺时间更长、CBS更低,术前白细胞、中性粒细胞、粒细胞和淋巴细胞比值(NLR)增高,淋巴细胞降低,侧支循环更差(均P<0.05)。PH组与NPH组比较,CBS更低、侧支循环更差,术前白细胞、中性粒细胞、NLR更高,闭塞血管多为颈内动脉(均P<0.05)。预后不良组和预后良好组比较,糖尿病患病率更高、静脉溶栓患者更多、CBS和取栓次数少,术前淋巴细胞计数降低,NLR增高,闭塞血管多为颈内动脉(均P<0.05)。二元Logistic回归分析表明CBS≤5分是机械取栓术后继发HT(P=0.032)、PH(P=0.047)的独立危险因素和术后90 d预后不良的独立危险因素(P=0.042)。结论CBS应用于机械取栓术治疗急性前循环大血管闭塞患者时,当CBS评分≤5分时既是HT和PH的独立危险因素,也是90 d预后不良的独立危险因素。

Aim To investigate the relationship among Clot Burden Score(CBS),secondary hemorrhagic transformation(HT)and 90-day prognosis in acute ischemic stroke(AIS)patients of pre-circulation large vessel occlusion treated with mechanical thrombectomy.Methods The data of 86 anterior circulation AIS patients who underwent mechanical thrombectomy were admitted to the Affiliated Hospital of Xuzhou Medical University from January to August in 2020.According to European Cooperative Acute Stroke Study(ECASS)Ⅱcriteria,the patients were divided into a HT group(30 cases)and a NHT group(56 cases).At the same,based on whether postoperative parenchymal hematoma(PH)occurred or not,the patients were divided into a PH group(11 cases)and a NPH group(75 cases).And according to the prognosis,the patients were divided into a good prognosis group(43 cases,mRS≤2)and a poor prognosis group(43 cases,3≤mRS≤6).The clinical data was compared between the two corresponding groups.Results Compared with the NHT group,the HT group had higher prevalence of hypertension,longer time from admission to puncture,less CBS and lymphocyte count,higher preoperative leukocyte count,neutrophil count,neutrophil lymphocyte ratio(NLR),and worse collateral circulation(P<0.05).Compared with the NPH group,the PH group had less CBS,worse collateral circulation,higher preoperative leukocyte and neutrophil count,NLR and more occluded vessels in internal carotid arteries(P<0.05).Compared with the good prognosis group,the poor prognosis group had higher prevalence of diabetes,more patients with intravenous thrombolysis,less CBS,preoperative lymphocyte count and pass of stent-retrieve,higher NLR,and more occluded vessels in internal carotid arteries(P<0.05).Binary Logistic analysis showed that CBS≤5 scores was an independent risk factor for both the secondary HT and PH after mechanical thrombectomy,and it was also an independent risk factor for poor prognosis at 90 days after mechanical thrombectomy.Conclusion When CBS was used for mechanical thrombectomy in patients with acute anterior circulation occlusion of large vessels,a score of less than or equal to 5 was an independent risk factor for HT,PH and poor prognosis at 90 days.