急性缺血性卒中患者血管侧支代偿情况及血流再通级别与机械取栓术预后的相关性研究

Relationship between vascular collateral compensation and blood flow recanalization and prognosis in patients with acute ischemic stroke after mechanical thrombectomy

目的探讨血管侧支代偿情况对急性缺血性卒中患者机械取栓术后预后的影响,并分析取栓术后无效再通的形成因素。方法采用回顾性队列研究方法,收集徐州医科大学附属医院于2020年10月—2022年5月收治的急性缺血性卒中并且接受机械取栓治疗的患者共155例。依据术后3个月改良Rankin量表(MRS)将其分为2组,一组为取栓术后预后良好组(MRS≤2分,n=84),另一组为取栓术后预后不良组(MRS≥3分,n=71)。其次,在血管再通(TICI 2b级/3级)的前提下将其分为有效再通组(TICI 2b级/3级且MRS≤2分,n=76)和无效再通组(TICI 2b级/3级且MRS≥3分,n=46)。收集以上所有患者的临床资料,包括术前ASITN/SIR分级、术前ASPECTS评分、术后MRS评分、NIHSS评分、TICI分级,以及人口统计学基本资料、脑血管病危险因素、辅助检查资料等。通过t检验、χ^(2)检验、U检验等分析方法及Logistic回归分析,分析以上因素对急性缺血性卒中患者机械取栓术后预后的影响,并应用受试者工作特征曲线分析各独立危险因素对急性缺血性卒中机械取栓术后预后的预测作用。结果单因素分析显示,预后良好组和预后不良组的术前NIHSS评分、术后1 h NIHSS评分、术后24 h NIHSS评分、术前ASITN/SIR分级、术前ASPECTS评分、术后TICI分级、白细胞计数、低密度脂蛋白胆固醇(LDL)、糖尿病史、糖化血红蛋白、同型半胱胺酸(HCY)、血糖差异有统计学意义(P<0.05)。多因素Logistic回归统计分析显示,2组ASITN/SIR分级(OR=0.342,95%CI=0.135~0.868,P<0.05)、TICI分级(OR=0.436,95%CI=0.195~0.975,P<0.05)、ASPECTS评分(OR=0.412,95%CI=0.274~0.619,P<0.05)差异有统计学意义(P<0.05),为预后不良的独立危险因素。2个亚组患者静脉溶栓、糖尿病史、血糖、术前ASPECTS评分、术后1 h NIHSS评分、术后24 h NIHSS评分、术前ASITN/SIR分级、术后TICI分级、中性粒细胞、总胆固醇、糖化血红蛋白、LDL、白细胞计数、HCY差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,2个亚组糖尿病(OR=3.278,95%CI=1.359~7.903,P<0.05)差异有统计学意义,为无效再通的独立危险因素。结论ASITN/SIR分级、TICI分级、ASPECTS评分与急性缺血性卒中患者机械取栓术后预后呈正相关,分数等级较低可作为预后不良的独立危险因素。患有糖尿病、术前ASPECTS评分低为无效再通的独立危险因素。

Objective To investigate the effect of vascular collateral compensation on the prognosis of patients with acute ischemic stroke after mechanical thrombectomy,and analyze the factors that cause ineffective recanalization after thrombectomy.Methods It was a retrospective cohort study.A total of 155 acute ischemic stroke patients who were admitted to the Affiliated Hospital of Xuzhou Medical University from October 2020 to May 2022 and underwent mechanical thrombectomy were enrolled.According to the modified Rankin Scale(MRS)scores three months after operation,they were divided into two groups:a good prognosis group(MRS≤2,n=84)and a poor prognosis group(MRS≥3,n=71).Then,on the basis of vessel recanalization(TICI 2b/3),they were divided into two groups:an effective recanalization group(TICI 2b/3 and MRS≤2,n=76)and an ineffective recanalization group(TICI 2b/3 and MRS≥3,n=46).Their clinical data were collected,including preoperative ASITN/SIR grade,preoperative ASPECTS score,postoperative MRS score,NIHSS score,TICI score,as well as basic demographic information,cerebrovascular disease risk factors,and auxiliary examination data.Then,the t-test,χ^(2)-Test,U-test and Logistic regression analysis were applied to analyze the impact of the above factors on the prognosis of patients with acute ischemic stroke after mechanical thrombectomy.The value of independent risk factors in predicting the prognosis of patients with acute ischemic stroke after mechanical thrombectomy was evalauted by the ROC curve.Results Univariate analysis showed that preoperative NIHSS score,postoperative 1 h NIHSS score,postoperative 24 h NIHSS score,preoperative ASITN/SIR grade,preoperative ASPECTS score,postoperative TICI grade,white blood cell count,low-density lipoprotein cholesterol(LDL),history of diabetes,glycosylated hemoglobin,homocysteine(HCY)and blood glucose were statistically different in both groups(P<0.05).Multivariate logistic regression analysis showed that ASITN/SIR grade(OR=0.342,95%CI=0.135-0.868,P<0.05),TICI grade(OR=0.436,95%CI=0.195-0.975,P<0.05)and ASPECTS score(OR=0.412,95%CI=0.274-0.619,P<0.05)were statistically significant(P<0.05),which were the independent risk factors for poor prognosis.Furthermore,there were statistical differences between the two subgroups in venous thrombolysis,diabetes history,blood sugar,preoperative ASPECTS score,postoperative 1 h NIHSS score,postoperative 24 h NIHSS score,preoperative ASITN/SIR grade,postoperative TICI grade,neutrophils,total cholesterol,glycosylated hemoglobin,LDL,white blood cell count,and HCY(P<0.05).Multivariate logistic regression analysis showed that diabetes(OR=3.278,95%CI=1.359-7.903,P<0.05)was statistically different,which was an independent risk factor for ineffective recanalization.Conclusions ASITN/SIR grade,TICI grade,ASPECTS score are positively correlated with the prognosis of patients with acute ischemic stroke after mechanical thrombectomy,and low scores and grades can be regarded as the independent risk factors for poor prognosis.Diabetes nistory and low preoperative ASPECTS score are the independent risk factors for ineffective recanalization.