肾功能损害及过高HDL-C对急性大血管闭塞性缺血性卒中血管内治疗患者预后的预测价值

Value of renal impairment and excessive HDL-C in predicting the prognosis of AIS-LVO patients receiving endovascular therapy

目的:探讨肾功能损害(RI)及过高高密度脂蛋白胆固醇(HDL-C)对急性大血管闭塞性缺血性卒中(AIS-LVO)血管内治疗(EVT)患者预后的预测价值。方法:回顾性分析2018年7月~2022年12月黄山市人民医院神经内科接受EVT治疗的AIS-LVO患者临床资料,根据估算肾小球过滤器(eGFR)分为RI组和非RI组,比较两组的相关资料,同时采用单因素及多因素Logistic回归分析探讨RI和其他可能的危险因素与接受EVT的AIS-LVO患者预后的相关性,运用ROC曲线及AUC分析比较RI联合其他可能的危险因素对90 d预后的预测价值。结果:本研究共纳入248例患者,多因素Logistic回归分析显示RI、基线ASPECTs、颈内动脉闭塞、过高HDL-C与90 d预后具有独立相关性(P<0.05)。RI联合过高HDL-C可以提高对90 d预后的预测能力(AUC=0.702,P<0.001)。结论:RI及过高HDL-C均是接受EVT的AIS-LVO患者90 d不良预后的独立危险因素,两者联合可以提高对90 d预后的预测能力。

Objective:To assess the value of renal impairment(RI)and excessive high-density lipoprotein cholesterol(HDL-C)in predicting the prognosis of patients with acute ischemic stroke caused by large vessel occlusions(AIS-LVO)during endovascular therapy(EVT).Methods:The clinical data were retrospectively analyzed in AIS-LVO patients receiving EVT in our department between July 2018 and December 2022.The cases were divided into RI group and non-RI group based on estimated glomerular filtration rate(eGFR).Univariate and multivariate logistic regression models were used to analyze the correlation between RI and other potential risk factors and the prognosis of AIS-LVO patients during EVT.ROC curve and AUC analysis were used to analyze the predictive value of RI combined with other possible risk factors on the 90-day prognosis.Results:A total of 248 patients were included in this study.Multivariate logistic regression analysis showed that RI,baseline ASPECTs,internal carotid artery occlusion and excessive HDL-C were independently correlated with 90-day prognosis(all P<0.05).RI combined with excessive HDL-C could improve the predictive ability of 90-day prognosis(AUC=0.702,P<0.001).Conclusion:Both RI and excessive HDL-C are independent risk factors for poor 90-day prognosis of AIS-LVO patients during EVT,and combined use of the two indicators can improve the predictive ability of 90-day prognosis.