低灌注强度比值对急性前循环大血管闭塞性卒中患者血管内取栓治疗预后的预测价值研究

Prognostic Value of Hypoperfusion Intensity Ratio in Patients with Acute Anterior Circulation Large Vessel Occlusion Stroke after Endovascular Thrombectomy

目的探讨低灌注强度比值(HIR)对急性前循环大血管闭塞性卒中(LVOS)患者血管内取栓治疗(EVT)预后的预测价值。方法回顾性选取2021年1月至2022年6月南阳市中心医院收治的接受EVT且影像学检查显示血管再通的急性前循环LVOS患者106例为研究对象。收集患者的临床资料,对其进行非增强CT、CT血管造影术、CT灌注成像检查,计算核心梗死区体积(V_(IC))、低灌注区体积(V_(Tmax>6 s))、严重低灌注区体积(V_(Tmax>10 s))、缺血半暗带区体积(V_(Mismatch))、HIR。术后随访90 d时采用改良Rankin量表(mRS)评价患者预后情况。采用多因素Logistic回归分析探讨急性前循环LVOS患者EVT预后的影响因素;采用ROC曲线分析年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分、发病至穿刺时间、HIR及其联合对急性前循环LVOS患者EVT预后不良的预测价值。结果随访结果显示,患者预后良好63例(预后良好组),预后不良43例(预后不良组)。两组年龄、有冠心病病史者占比、入院时NIHSS评分、CT平扫Alberta卒中项目早期CT评分(ASPECTS)、V_(IC)、V_(Tmax>10 s)、HIR比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄〔OR=1.056,95%CI(1.006,1.108)〕、入院时NIHSS评分〔OR=1.101,95%CI(1.013,1.197)〕、发病至穿刺时间〔OR=1.003,95%CI(1.001,1.006)〕、HIR〔OR=492.435,95%CI(29.371,8256.315)〕是急性前循环LVOS患者EVT预后的独立影响因素(P<0.05)。ROC曲线分析结果显示,年龄、入院时NIHSS评分、HIR及三者联合预测急性前循环LVOS患者EVT预后不良的AUC分别为0.612〔95%CI(0.504,0.721)〕、0.703〔95%CI(0.601,0.805)〕、0.754〔95%CI(0.655,0.853)〕、0.803〔95%CI(0.719,0.886)〕。三者联合与HIR预测急性前循环LVOS患者EVT预后不良的AUC比较,差异无统计学意义(P>0.05)。结论年龄增长、入院时NIHSS评分升高、发病至穿刺时间延长、HIR升高是急性前循环LVOS患者EVT预后不良的危险因素,且HIR对急性前循环LVOS患者EVT预后不良具有中等预测价值。

Objective To investigate the prognostic value of hypoperfusion intensity ratio(HIR)in patients with acute anterior circulation large vessel occlusion stroke(LVOS)after endovascular thrombectomy(EVT).Methods A total of 106 patients with acute anterior circulation LVOS who received EVT and whose imaging findings showed vascular recanalization in Nanyang Central Hospital from January 2021 to June 2022 were retrospectively selected as the research subjects.The general data of the patients were collected.Non-contrast CT,computed tomography angiography and computed tomography perfusion were performed,the volume of core infarction area(V_(IC)),the volume of the hypoperfusion area(V_(Tmax>6 s)),the volume of the severe hypoperfusion area(V_(Tmax>10 s)),the volume of the ischemic penumbra(V_(Mismatch)),and HIR were calculated.The patients were followed up for 90 days and the prognosis was evaluated using the modified Rankin scale(mRS).Multivariate Logistic regression analysis was used to explore the influencing factors of prognosis in patients with acute anterior circulation LVOS after EVT.ROC curve was used to analyze the predictive value of age,National Institutes of Health Stroke Scale(NIHSS)score at admission,time from onset to puncture,HIR and their combination for poor prognosis in patients with acute anterior circulation LVOS after EVT.Results The follow-up results showed that 63 patients had a good prognosis(good prognosis group)and 43 patients had a poor prognosis(poor prognosis group).There was significant difference in age,the proportion of patients with history of coronary heart disease,NIHSS score at admission,Alberta Stroke Program Early CT Score(ASPECTS),V_(IC),V_(Tmax>10 s) and HIR between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age[OR=1.056,95%CI(1.006,1.108)],NIHSS score at admission[OR=1.101,95%CI(1.013,1.197)],time from onset to puncture[OR=1.003,95%CI(1.001,1.006)]and HIR[OR=492.435,95%CI(29.371,8256.315)]were the independent influencing factors of prognosis in patients with acute anterior circulation LVOS after EVT(P<0.05).ROC curve analysis showed that AUC of age,NIHSS score at admission,HIR and their combination in predicting for poor prognosis in patients with acute anterior circulation LVOS after EVT was 0.612[95%CI(0.504,0.721)],0.703[95%CI(0.601,0.805)],0.754[95%CI(0.655,0.853)],0.803[95%CI(0.719,0.886)],respectively.There was no statistically significant difference in AUC between their combination and HIR in predicting poor prognosis in patients with acute anterior circulation LVOS after EVT(P>0.05).Conclusion Increased age,increased NIHSS score at admission,prolonged time from onset to puncture and increased HIR are the risk factors for poor prognosis in patients with acute anterior circulation LVOS after EVT.HIR has moderate predictive value for poor prognosis in patients with acute anterior circulation LVOS after EVT.