脑血容量指数预测超时间窗前循环大血管闭塞病人血管内治疗预后的价值

Predictive value of cerebral blood volume index in assessing the prognosis of stroke patients with anterior circulation large vessel occlusion in the extended time window after endovascular therapy

目的探讨脑血容量指数(CBV Index)在预测超时间窗(>6 h)前循环大血管闭塞急性缺血性卒中(AIS)病人血管内治疗(EVT)后90 d神经功能结局中的价值。方法回顾性纳入EVT后超时间窗前循环大血管闭塞AIS病人137例,分析病人的一般临床资料和头颅CT灌注(CTP)影像。根据术后90 d改良Rankin量表(mRS)评分,将病人分为预后良好组(mRS≤2分)60例和预后不良组(mRS>2分)77例。采用Mann-Whitney U检验、卡方检验或Fisher确切概率检验比较2组间梗死核心体积、CBV Index、低灌注强度比(HIR)和一般临床资料。采用多因素Logistic回归分析并构建超时间窗前循环大血管闭塞AIS病人EVT后预后预测模型。采用受试者操作特征(ROC)曲线下面积(AUC)分析预测效能。结果与预后不良组比较,预后良好组病人的年龄小、男性占比高、入院时NIHSS评分低,且梗死核心体积小、血管再开通良好比例高、CBV Index高、HIR低(均P<0.05)。Logistic回归分析显示年龄、入院时NIHSS评分、血管再开通情况和CBV Index是预测超时间窗前循环大血管闭塞AIS病人EVT后预后的独立预测因子(均P<0.05)。ROC曲线分析显示整合了年龄、入院时NIHSS评分、血管再开通情况和CBV Index的联合模型对病人预后具有较高的预测效能,AUC为0.878,敏感度为81.67%,特异度为87.01%。结论CBV Index与超时间窗前循环大血管闭塞AIS病人EVT后90 d神经功能结局相关,整合了年龄、入院时NIHSS评分、血管再开通情况和CBV Index的模型可有效预测预后。

Objective To investigate the predictive value of cerebral blood volume index(CBV Index)for the 90-day neurological outcomes in acute ischemic stroke(AIS)patients with anterior circulation large vessel occlusion in the extended time window(>6 h)after endovascular therapy(EVT).Methods This retrospective study enrolled 137 AIS patients with anterior circulation large vessel occlusion in extended time window after EVT.General clinical data and brain computed tomography perfusion(CTP)images were analyzed.Patients were categorized into two groups based on the modified Rankin Scale(mRS)at 90 days after EVT,defining a good outcome as mRS≤2(60 cases)and a poor outcome as mRS>2(77 cases).Volume of infarct core,CBV Index,hypoperfusion intensity ratio(HIR),and general clinical data were compared between two groups using Mann-Whitney U test,chi-square test or Fisher’s exact test.Multivariate Logistic regression analysis was used to construct a prognostic prediction model,and area under the curve(AUC)of receiver operating characteristic(ROC)was used to assess predictive efficiency.Results The good outcome group exhibited lower age,a higher proportion of males,and a lower NIHSS score on admission compared to the poor outcome group(all P<0.05).Additionally,patients with a favorable prognosis had smaller volume of infarct core,successful recanalization,higher CBV Index,and lower HIR(all P<0.05).Logistic regression analysis identified age,NIHSS score on admission,recanalization,and CBV Index as independent predictors of prognosis in AIS patients with anterior circulation large vessel occlusion in the extended time window after EVT(all P<0.05).ROC curve analysis showed that the model integrating age,NIHSS score on admission,recanalization,and CBV Index had excellent predictive efficiency for prognosis,with an AUC of 0.878,sensitivity of 81.67%,and specificity of 87.01%.Conclusion CBV Index is associated with the 90-day neurological outcome in AIS patients with anterior circulation large vessel occlusion in the extended time window after EVT.The model integrating age,NIHSS score on admission,recanalization,and CBV Index can effectively predict the prognosis.