急性缺血性脑卒中患者再灌注治疗后幽灵梗死核心情况及其相关因素分析

Analysis of ghost infarct core and related factors in patients with acute ischemic stroke after reperfusion therapy

目的探讨急性缺血性脑卒中患者再灌注治疗后幽灵梗死核心(GIC)情况及其相关因素。方法回顾性选取四川绵阳四〇四医院2019年8月至2021年1月接受再灌注治疗的急性缺血性脑卒中患者作为研究对象,收集所有患者一般资料、计算机断层扫描灌注(CTP)资料,评估所有患者GIC(初始核心梗死区-最终梗死区>10 mL)发生情况,并根据是否存在GIC分为GIC组和非GIC组。采用多因素Logistic回归分析术后再灌注治疗GIC发生的相关因素。结果根据纳入标准和排除标准共入选228例患者,其中43例出现GIC为GIC组,其余185例未出现GIC为非GIC组;两组入院时血糖、达峰时间、症状发作至开始CTP时间、症状发作至再通时间对比差异具有统计学意义(t=4.416、5.124、3.601、4.959,P<0.05);多因素Logistic分析显示:入院时血糖高、达峰时间长、症状发作至开始CTP时间短、症状发作至再通时间短是急性缺血性脑卒中患者再灌注治疗后出现GIC的独立影响因素[OR(95%CI)=1.993(1.414~2.810)、2.657(1.815~3.889)、0.972(0.951~0.993)、0.971(0.958~0.985),均P<0.05]。结论入院时血糖、达峰时间、症状发作至开始CTP时间、症状发作至再通时间是急性缺血性脑卒中再灌注治疗GIC的独立影响因素。

Objective To investigate the ghost infarct core(GIC)and related factors in acute ischemic stroke patients after reperfusion therapy.Methods Patients with acute ischemic stroke received reperfusion therapy in Sichuan Mianyang 404 Hospital from August 2019 to January 2021 were retrospectively selected as research subjects.General data and computed tomography perfusion(CTP)data of all patients were collected.All patients were evaluated for the occurrence of GIC(initial core infarct area-final infarct area>10 mL),and divided into GIC group and non-GIC group according to the presence and absence of GIC.Multivariate Logistic regression was used to analyze the related factors of GIC after postoperative reperfusion.Results A total of 228 patients were enrolled according to the inclusion and exclusion criteria,among which 43 patients showed GIC(GIC group)and the remaining 185 patients did not(non-GIC group).Differences in blood glucose at admission,time to peak,time from symptom onset to CTP and time from symptom onset to recanalization between the two groups were statistically significant(t=4.416,5.124,3.601,4.959;P<0.05).Multivariate Logistic analysis showed that high blood glucose at admission,long time to peak,short time from symptom onset to CTP and short time from symptom onset to recanalization were independent influencing factors of GIC after reperfusion therapy in patients with acute ischemic stroke[OR(95%CI)=1.993(1.414-2.810),2.657(1.815-3.889),0.972(0.951-0.993),0.971(0.958-0.985);all P<0.05].Conclusion Blood glucose at admission,time to peak,time from symptom onset to CTP and time from symptom onset to recanalization were independent influencing factors of GIC after reperfusion therapy for acute ischemic stroke.