B/A比值与老年急性颅内大动脉闭塞狭窄程度以及预后的关系

Relationship between B/A ratio and the degree of acute intracranial arterial occlusion and stenosis and prognosis in elderly patients

目的探讨血清总胆红素/白蛋白(B/A)比值与老年急性颅内大动脉闭塞(LVO)狭窄程度、机械取栓后侧支循环以及神经预后的关系。方法选择2018年3月—2023年3月邢台市第三医院收治的109例行机械取栓治疗的LVO患者(LVO组),根据梗死动脉狭窄程度分为轻度狭窄组(36例)、中度狭窄组(45例)和重度狭窄组(28例),根据术后改良的美国介入和治疗神经放射学会/介入放射学会(ASITN/SIR)侧支循环分级分为侧支循环较好组(31例)、侧支循环中等组(49例)和侧支循环较差组(29例),根据mRS评分分为神经预后良好组(27例)和神经预后不良组(82例),另选择同期我院门诊体检中心就诊的63例体检者为对照组。收集临床信息以及术前(对照组体检日)血清直接胆红素、间接胆红素、总胆红素(TBiL)、白蛋白水平,计算B/A比值,比较组间B/A比值差异,分析B/A比值对神经预后的预测价值。结果LVO组血清间接胆红素、TBiL、白蛋白、B/A比值低于对照组(P<0.05)。重度狭窄组血清间接胆红素、TBiL、白蛋白、B/A比值低于中度狭窄组和轻度狭窄组(P<0.05),侧支循环较差组血清间接胆红素、TBiL、白蛋白、B/A比值低于侧支循环较好组和侧支循环中等组(P<0.05),神经预后不良组血清TBiL、白蛋白、B/A比值低于神经预后良好组(P<0.05)。B/A比值预测LVO患者机械取栓后90 d神经预后不良的曲线下面积为0.870,大于TBiL、白蛋白的0.659、0.633(Z=3.647、3.838,P<0.05)。结论老年LVO患者血清TBil、白蛋白水平、B/A比值下降与LVO动脉狭窄程度加重,与术后侧支循环开放程度较差及神经预后恢复程度不良有关,B/A比值下降在LVO神经预后预测中具有较高价值。

Objective To investigate the relationship between total bilirubin/albumin(B/A)ratio and the severity of acute large vessel occlusion(LVO)stenosis,collateral circulation and neurological prognosis after mechanical thrombectomy.Methods 109 LVO patients(LVO group)who underwent mechanical thrombectomy in our hospital from March 2018 to March 2023 were retrospectively selected.According to the severity of infarcted artery stenosis,they were divided into mild stenosis group(36 cases),moderate stenosis group(45 cases)and severe stenosis group(28 cases).According to the modified American Society of Interventional and Therapeutic Neuroradiology/Interventional Radiology(ASITN/SIR)collateral circulation classification,the patients were divided into the better collateral circulation group(31 cases),the moderate collateral circulation group(49 cases)and the poor collateral circulation group(29 cases).According to mRS score,they were divided into good neurological prognosis group(27 cases)and bad neurological prognosis group(82 cases).In addition,63 patients receiving physical examination in the outpatient physical examination center of our hospital during the same period were selected as the control group.Clinical information and serum direct bilirubin,indirect bilirubin,TBiL and albumin levels before surgery(physical examination day of control group)were collected to calculate the B/A ratio,compare the B/A ratio difference between groups,and analyze the predictive value of B/A ratio for neurological prognosis.Results The ratios of serum indirect bilirubin,TBiL,albumin and B/A in LVO group were lower than those in control group(P<0.05).The ratios of serum indirect bilirubin,TBiL,albumin and B/A in severe stenosis group were lower than those in moderate and mild stenosis group(P<0.05),and the ratios of serum indirect bilirubin,TBiL,albumin and B/A in poor collateral circulation group were lower than those in good collateral circulation group and moderate collateral circulation group(P<0.05).The ratio of serum TBiL,albumin and B/A in the group with poor neurological prognosis were lower than those in the group with good neurological prognosis(P<0.05).The area under the curve of B/A ratio predicting poor neurological prognosis of LVO patients 90 days after mechanical thrombolectomy was 0.870,which was higher than 0.659 and 0.633 of TBiL and albumin(Z=3.647 and 3.838,P<0.05).Conclusion Low serum TBil,albumin levels and B/A ratio in LVO patients are associated with the aggravation of LVO artery stenosis,poor degree of collateral circulation opening and poor degree of neurological prognosis recovery,and THE B/A ratio has A high value in the prediction of neurological prognosis of LVO patients.