THRIVE评分、NLR值、D-二聚体与急性脑梗死取栓患者预后的相关性

Correlation of THRIVE score,NLR,and D-dimer with prognosis in patients undergoing thrombectomy for acute ischemic stroke

目的分析取栓术前血管事件健康风险(THRIVE)评分联合中性粒细胞-淋巴细胞百分比(NLR)、D-二聚体与缺血性脑卒中取栓术(EVT)后预后的相关性,以及预测不良结局价值。方法回顾性连续纳入了前循环取栓治疗的165例患者临床资料,并以90 d的改良Rankin量表(mRS)评分进行分组,其中mRS评分0~3为结局良好组,mRS评分4~6为结局不良组。主要指标是在取栓术后90 d内的mRS评分,次要指标包括术后3 d内出现症状性颅内出血和(或)恶性脑水肿(MCE)以及术后30 d内病死率。采用单因素和多因素logistic回归模型来探讨相关因素,并使用受试者工作特征(ROC)曲线来分析这些因素对不良结局预测价值。结果在结局不良组中,年龄、基线美国国立卫生研究院卒中量表(NIHSS)评分、DSA-侧支循环、THRIVE评分、NLR值和D-二聚体等因素差异有统计学意义(P<0.05)。多因素logistic回归模型分析显示,基线NIHSS评分、DSA-侧支循环、THRIVE评分、术前NLR和D-二聚体与取栓术后不良结局相关(P<0.05)。ROC曲线下面积的分析结果显示,基线NIHSS曲线下面积为0.829,THRIVE评分曲线下面积为0.768,NLR曲线下面积为0.921,D-二聚体评分曲线下面积为0.732。当联合THRIVE评分、术前NLR和D-二聚体时,ROC曲线下面积达到最大值为0.957(95%CI:0.929~0.985,P=0.000),差异均有统计学意义(P<0.05)。结论THRIVE评分、术前NLR值、D-二聚体与缺血性脑卒中取栓术后不良结局密切相关,基线NIHSS评分和DSA-侧支循环也是影响术后不良结局的独立危险因素。联合应用THRIVE评分、术前NLR值和D-二聚体能够有效预测不良预后,并具有指导临床实践的重要意义。

Objective To analyze the correlation between pre-thrombectomy THRIVE score,neutrophil-lymphocyte ratio(NLR),and D-dimer levels with the prognosis of patients undergoing endovascular treatment(EVT)for acute ischemic stroke,and to explore their predictive value for adverse outcomes.Methods A retrospective study was conducted on the clinical data of 165 patients who underwent anterior circulation thrombectomy.Patients were categorized based on their 90-day modified Rankin Scale(mRS)scores into a good outcome group(mRS 0-3)and a poor outcome group(mRS 4-6).The primary outcome was the mRS score at 90 days post-thrombectomy,while secondary outcomes included symptomatic intracranial hemorrhage and/or malignant cerebral edema(MCE)within 3 days post-surgery,and 30-day mortality rate.Univariate and multivariate logistic regression models were used to identify related factors,and receiver operating characteristic(ROC)curves were used to analyze the predictive value of these factors for adverse outcomes.Results In the poor outcome group,age,baseline NIH Stroke Scale(NIHSS)scores,DSA-collateral circulation,THRIVE scores,NLR values,and D-dimer levels were significantly different compared to the good outcome group(P<0.05).Multivariate logistic regression analysis indicated that baseline NIHSS scores,DSA-collateral circulation,THRIVE scores,preoperative NLR,and D-dimer levels were associated with poor outcomes post-thrombectomy(P<0.05).The area under the ROC curve(AUC)for baseline NIHSS,THRIVE scores,NLR,and D-dimer were 0.829,0.768,0.921,and 0.732,respectively.When combining THRIVE score,preoperative NLR,and D-dimer,the AUC increased to 0.957(95%CI:0.929-0.985,P=0.000),showing a statistically significant difference(P<0.05).Conclusion THRIVE score,preoperative NLR,and D-dimer levels are closely related to adverse outcomes following EVT for acute ischemic stroke.Baseline NIHSS scores and DSA-collateral circulation are also independent risk factors for poor outcomes.The combined use of THRIVE scores,preoperative NLR,and D-dimer levels provides effective prediction of adverse prognoses,offering significant guidance for clinical practice.