基底动脉弯曲与脑干梗死患者早期预后不良的相关性研究

Correlation between basilar artery tortuosity and poor early prognosis in patients with brainstem infarction

目的探讨基底动脉弯曲与脑干梗死患者早期预后不良的关系。方法回顾性纳入2020年4月至2022年5月常州市第二人民医院神经内科收治的脑干梗死患者171例,根据患者入院72 h内扩展版美国国立卫生研究院卒中量表(e-NIHSS)评分是否较入院时增加≥2分,分为预后不良组46例与预后良好组125例。所有患者均完成头颅MRI检查和CT血管造影(CTA)检查,收集入组患者的相关基线资料和入院e-NIHSS评分等。比较2组患者的基线临床资料及脑干梗死部位等,评估脑干梗死患者早期预后不良的预测因素。结果2组高血压、入院e-NIHSS评分、椎动脉优势和基底动脉弯曲指数比较,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,高血压(OR=3.498,95%CI:1.085~11.271,P=0.036)、入院e-NIHSS评分(OR=1.217,95%CI:1.020~1.453,P=0.029)和基底动脉弯曲指数(OR=1.317,95%CI:1.159~1.496,P=0.001)是脑干梗死患者早期预后不良的独立预测因素。ROC曲线分析发现,基底动脉弯曲指数预测脑干梗死早期预后不良的最佳截断值为0.612,曲线下面积为0.833(95%CI:0.761~0.905),敏感性为80.4%,特异性为80.8%。结论基底动脉弯曲是脑干梗死患者早期预后不良的有效预测指标。

Objective To investigate the relationship between basilar artery tortuosity and poor early prognosis in patients with brainstem infarction.Methods Clinical data of 171 patients with brainstem infarction admitted to the Department of Neurology of Changzhou Second People􀆳s Hospital from April 2020 to May 2022 were retrospectively collected.According to whether the score of the extended version of National Institutes of Health Stroke Scale(e-NIHSS)increased by≥2 points within 72 h after admission,the patients were divided into poor early prognosis group(n=46)and good prognosis group(n=125).All patients completed head MRI scanning and CT angiography(CTA).The baseline data and e-NIHSS score at admission were compared and analyzed for the factors for brainstem infarction and predictors of early poor prognosis in these patients.Results There were significant differences in proportion of hypertension,admission e-NIHSS score,vertebral artery dominance and basilar artery tortuosity index between the 2 groups(P<0.05,P<0.01).Multivariate logistic regression analysis showed that hypertension(OR=3.498,95%CI:1.085-11.271,P=0.036),admission e-NIHSS score(OR=1.217,95%CI:1.020-1.453,P=0.029)and basilar artery tortuosity index(OR=1.317,95%CI:1.159-1.496,P<0.001)were independent predictors of poor early prognosis in patients with brainstem infarction.Further ROC curve analysis indicated that the cut-off value of basilar artery tortuosity index for predicting poor early prognosis of brainstem infarction was 0.612,the area under the curve was 0.833(95%CI:0.761-0.905),the sensitivity was 80.4%,and the specificity was 80.8%.Conclusion Basilar artery tortuosity is an effective predictor of poor early prognosis in patients with brainstem infarction.