急性前循环大血管闭塞性脑卒中患者梗死核心体积的影响因素及其与临床预后的相关性

Factors associated with ischemia core volume in patients with acute anterior circulation large vessel occlusive stroke and its correlation with clinical outcome

目的分析急性前循环大血管闭塞性脑卒中(acute anterior circulation large vessel occlusive stroke,ALVOS)患者梗死核心体积(ischemia core volume,ICV)大小的影响因素及其与临床预后的关系。方法回顾性收集2022年1月至2022年9月邯郸市中心医院神经内科收治的ALVOS患者62例,其中男性40例,女性22例,平均年龄65.6岁。根据ICV大小将患者分为小ICV(small-ICV,S-ICV)组(ICV<50 mL,n=38)和大ICV(large-ICV,L-ICV)组(ICV≥50 mL,n=24),比较两组患者间临床特征的差异;采用多因素Logistic回归分析ALVOS患者形成L-ICV的独立影响因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线评估ICV对ALVOS患者临床预后的预测效能;采用Kaplan-Meier生存分析法探讨ICV对患者生存期影响;采用Cox风险回归分析法分析ALVOS并发L-ICV患者发生死亡的危险因素。结果与S-ICV患者比较,L-ICV患者美国国立卫生研究院卒中量表(NIHSS)评分及血红蛋白浓度较高,区域软脑膜侧支循环(regional leptomeningeal collateral,rLMC)评分以及合并高血压史比例较低(P<0.05);多因素Logistic回归分析显示血红蛋白浓度高(OR=1.082,95%CI:1.020~1.148;P<0.01)是ALVOS患者发生L-ICV的独立危险因素,而rLMC评分高(OR=0.788,95%CI:0.678~0.916;P<0.01)是发生L-ICV的保护性因素。ROC曲线分析显示预后良好和不良的ICV截断值是52.55 mL。Kaplan-Meier生存分析显示L-ICV组患者的累计生存率明显低于S-ICV组(P<0.05)。进一步对L-ICV组进行多因素Cox风险回归分析结果显示,症状性颅内出血(HR=28.855,95%CI:2.975~279.849,P<0.05)和糖尿病(HR=13.832,95%CI:1.040~183.820,P<0.05)是L-ICV组患者生存的独立影响因素。结论血红蛋白水平高是ALVOS患者形成L-ICV的独立危险因素,而rLMC评分高是其保护性因素。ICV大小对ALVOS患者的预后具有良好的预测价值。L-ICV ALVOS患者预后良好率、累计生存率低于S-ICV,其中症状性颅内出血和糖尿病是L-ICV患者生存的独立影响因素。

Objective To analyze the influencing factors of ischemia core volume(ICV)size in patients with acute anterior circulation large vessel occlusive stroke(ALVOS),and to evaluate the correlation between ICV size and clinical prognosis.Methods A total of 62 patients with ALVOS admitted to the Department of Neurology,Handan Central Hospital from January 2022 to September 2022 were retrospectively collected,including 40 males and 22 females,the average aged was 65.6 years.The patients were divided into the small ICV(S-ICV)group(ICV<50 mL,n=38)and the large ICV(L-ICV)group(ICV≥50 mL,n=24),according to the ICV.The differences in clinical characteristics between the two groups were compared.Multivariate logistic regression was used to analyze the independent influencing factors of L-ICV in patients with ALVOS.The receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of ICV for the clinical prognosis of ALVOS patients.Kaplan-Meier survival analysis was used to explore the effect of ICV on the survival of patients.Cox regression analysis was used to analyze the risk factors of death in patients with ALVOS complicated with L-ICV.Results Compared with patients with S-ICV,patients with L-ICV had higher National Institutes of Health Stroke Scale(NIHSS)score and hemoglobin concentration,and lower regional leptomeningeal collateral(rLMC)score and the proportion of history of hypertension(P<0.05).Multivariate Logistic regression analysis showed that high hemoglobin concentration(OR=1.082,95%CI:1.020-1.148;P<0.01)was an independent risk factor for L-ICV,while high rLMC(OR=0.788,95%CI:0.678-0.916;P<0.01)was the protective factor for L-ICV.To distinguish good and poor prognosis,the cut-off value of ICV is 52.55 mL.Kaplan-Meier survival analysis showed that the cumulative survival rate of patients in the L-ICV group was significantly lower than that in the S-ICV group(P<0.05).Further subgroup multivariate cox risk regression analysis showed that symptomatic intracranial hemorrhage(sICH)(HR=28.855,95%CI:2.975-279.849;P<0.05)and diabetes(HR=13.832,95%CI:1.040-183.820;P<0.05)were independent risk factors for survival in L-ICV group.Conclusions High hemoglobin concentration is an independent risk factor for L-ICV in patients with ALVOS,while high rLMC score is a protective factor.ICV size has a good predictive value for the prognosis of patients with ALVOS.The good prognosis rate and cumulative survival rate of ALVOS patients with L-ICV were significantly lower than those in the group of S-ICV.sICH and diabetes are independent survival factors for L-ICV patients.