基于MRA评估基底动脉闭塞预后评分预测非重症基底动脉闭塞患者预后效能的研究

A Novel BAOPS-MRA Score Predicts Outcome in Nonsevere Basilar Artery Occlusion

目的探索新的基底动脉影像学评分方法——基于MRA评估基底动脉闭塞预后评分(basilar artery occlusion prognosis score on magnetic resonance angiography,BAOPS-MRA)及其对非重症基底动脉闭塞患者预后的评估效果。方法提出基于MRA的新型基底动脉评分方法——BAOPS-MRA及其动脉节段评分标准。前瞻性连续入组2019年1月-2020年12月经头颅MRA诊断为基底动脉闭塞且NIHSS≤15分的后循环缺血性卒中患者,在该患者群体中评估BAOPS-MRA预测发病3个月功能预后的效能。根据发病3个月的随访结果,将患者分为预后良好(mRS≤2分)组和预后不良(mRS>2分)组,基于患者入院时的MRA结果,评定BAOPS-MRA,同时评定既往研究者提出的基于MRA的基底动脉和侧支循环的评分(basilar artery and collateration score on magnetic resonance angiography,BACS-MRA)。采用单因素和多因素方法分析两组的基线资料、血管狭窄部位和程度、BAOPS-MRA、BACS-MRA与3个月预后的关系。采用ROC曲线评估BAOPS-MRA预测患者预后的效能,并与BACS-MRA的预测效能进行比较。对BAOPS-MRA、BACS-MRA与发病3个月预后进行相关性分析。结果共纳入99例患者,其中预后良好组65例,预后不良组34例。预后良好组的BAOPS-MRA评分为7.0(2.0~16.0)分,预后不良组为2.5(0~12.0)分。多因素分析显示,BAOPS-MRA(OR 1.577,95%CI1.238~2.008,P=0.001)、BACS-MRA(OR 1.488,95%CI 1.193~1.857,P=0.001)、NIHSS(OR 0.786,95%CI 0.670~0.923,P=0.003)是患者3个月功能预后的独立影响因素。ROC曲线分析显示,BAOPSMRA评分预测3个月预后的截断值为5分,AUC为0.850(95%CI 0.765~0.936),敏感度为0.794,特异度为0.754;BACS-MRA预测3个月预后的截断值为4分,AUC为0.747(95%CI 0.641~0.852),敏感度为0.765,特异度为0.585,BAOPS-MRA较BACS-MRA的预测效能更佳。BAOPS-MRA(rs=0.580,P<0.001)、BACS-MRA(rs=0.409,P<0.001)与患者3个月预后良好呈正相关性。结论BAOPS-MRA评分可独立预测非重症基底动脉闭塞患者的3个月功能预后,具有一定的临床推广价值。

Objective To evaluate the predictive value of a new basilar artery occlusion prognosis score based on MRA the basilar artery occlusion prognosis score on magnetic resonance angiography(BAOPS-MRA)for the 90-day functional prognosis of patients with non-severe basilar artery occlusion.Methods We proposed the scoring method based on MRA of BAOPS-MRA score.This prospective cohort enrolled the consecutive patients with posterior circulation ischemic stroke diagnosed with basilar artery occlusion and NIHSS≤15 from January 2019 to December 2020.According to the follow-up results at 3 months of stroke onset,the patients were divided into good prognosis(m RS≤2)group and poor prognosis(m RS>2)group.Based on MRA results at admission,the BAOPS-MRA score,and the basilar artery and collateral circulation score on MRA(BACS-MRA)score were evaluated.Multivariate logistic regression analysis was performed to analyze the relationship between baseline data,BAOPS-MRA,BACS-MRA and 90-day prognosis.The ROC curve was used to evaluate the predictive efficacy of the two scores for 90-day prognosis,and the predictive value of the two scores was compared.Spearman correlation analysis was used to analyze the correlation of BAOPS-MRA and BACS-MRA with 90-day m RS.Results A total of 99 patients were included,including 65 in good prognosis group and 34 in poor prognosis group.The BAOPS-MRA score was 7.0(2.0-16.0)in good prognosis group and 2.5(0-12.0)in poor prognosis group.Multivariate analysis showed that BAOPS-MRA(OR 1.577,95%CI 1.238-2.008,P=0.001),BACS-MRA(OR 1.488,95%CI 1.193-1.857,P=0.001),NIHSS(OR 0.786,95%CI 0.670-0.923,P=0.003)were independent predictors of functional outcome at 3 months.ROC curve analysis showed that the cut-off value of BAOPS-MRA score for predicting 90-day prognosis was 5,the area under the curve(AUC)was 0.850(95%CI 0.765-0.936),the sensitivity was 0.794,and the specificity was 0.754;the cut-off value of BACS-MRA for predicting 90-day prognosis was 4,the AUC was 0.747(95%CI 0.641-0.852),the sensitivity of 0.765,and the specificity was 0.585.BAOPS-MRA was better than BACS-MRA in predicting 90-day functional prognosis of patients with basilar artery occlusion.BAOPS-MRA(rs=0.580,P<0.001)and BACSMRA(rs=0.409,P<0.001)were positively correlated with 90-day good prognosis.Conclusions The BAOPS-MRA score can independently predict the 90-day functional prognosis of patients with non-severe basilar artery occlusion,which has a certain clinical value.