机械血栓切除术治疗前后循环急性大血管闭塞性缺血性卒中患者的效果及预后的影响因素

Effect and prognostic factors of mechanical thrombectomy for anterior and posterior circulation acute ischemic stroke with large vessel occlusion patients

目的观察机械血栓切除术(MT)治疗前后循环急性大血管闭塞性缺血性卒中(AIS-LVO)患者的临床效果,分析影响其预后的相关因素。方法选取2019-04—2023-04沧州市人民医院神经内科收治的124例AIS-LVO患者为研究对象,根据术后随访90 d改良Rankin量表(mRS)评分分成预后良好组和预后不良组,分析2组患者临床基本情况、NIHSS评分、闭塞血管部位、血压、ASPECT评分、手术及预后指标,将有统计学差异的因素纳入多因素Logistic回归模型,通过受试者工作(ROC)特征分析影响因素对预后的预测效能。结果124例患者中预后良好45例,预后不良79例,2组患者在入院时NIHSS评分、闭塞血管位置、血压及ASPECT评分、发病至入院时间、入院到再通时间、再通成功、血管再通分级(TICI)、24 h内发生颅内出血、术后90 d mRS评分、90 d死亡方面差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,入院时NIHSS评分增高(P=0.014,OR=2.065)、入院时血压升高(P=0.044,OR=1.033)、ASPECT评分增高(P=0.001,OR=1.741)、发病至入院时间较长(P=0.002,OR=2.912)、入院到再通时间增加(P=0.001,OR=1.025)以及24 h内颅内出血(P=0.034,OR=4.033)会增加预后不良的概率。ROC曲线分析显示,Logistic回归分析模型预测AIS-LVO患者机械血栓切除术预后的曲线下面积(AUC)为0.768(95%CI:0.861~0.962,P<0.001),灵敏度为74.68%,特异度为97.78%。结论入院时NIHSS评分、血压、ASPECT评分、发病至入院时间、入院到再通时间以及24 h内颅内出血情况是影响AIS-LVO患者预后的危险因素,以这些因素建立的预测模型具有较好诊断效能,多因素综合分析可作为MT治疗AIS-LVO患者预后的重要预测指标。

Objective To observe the clinical effect of mechanical thrombectomy(MT)in the treatment of anterior and posterior circulation acute ischemic stroke with large vessel occlusion(AIS-LVO),and analyze the related factors affecting the prognosis.Methods A total of 124 patients with AIS-LVO admitted to Department of Neurology,Cangzhou People’s Hospital from April 2019 to April 2023 were selected as the research objects.According to mRS score at 90 days after operation,they were divided into the good prognosis group and the poor prognosis group.The basic clinical characteristics,NIHSS score,occlusion vessel location,blood pressure,ASPECT score,surgical and prognostic indicators of the two groups were analyzed.The statistically significant factors were included in the multivariate Logistic regression model,and the receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of the influencing factors for the prognosis.Results There were 45 patients with good prognosis and 79 patients with poor prognosis.There was significant difference between the two groups in NIHSS score,location of occluded vessel,blood pressure and ASPECT score,time from admission to recanalization,successful recanalization,vascular recanalization grade(TICI),intracranial hemorrhage within 24 hours,mRS score at 90-day after operation,deaths at 90-day after operation between the two groups(P<0.05).Multivariate Logistic regression analysis showed that increased NIHSS score(P=0.014,OR=2.065),increased blood pressure at admission(P=0.044,OR=1.033),increased ASPECT score(P=0.001,OR=1.741),longer time from admission to recanalization(P=0.002,OR=2.912),increased time from admission to reopening(P=0.001,OR=1.025),and intracranial hemorrhage within 24 hours(P=0.034,OR=4.033)increased the probability of poor prognosis.ROC analysis showed that the area under the curve(AUC)of Logistic regression analysis model for predicting the prognosis of mechanical thrombectomy in patients with AIS-LVO was 0.768(95%CI:0.861-0.962,P<0.001).The sensitivity was 74.68 specificity was 97.%and the 78%.Conclusion NIHSS score at admission,blood pressure,ASPECT score,time from onset to admission,time from admission to recanalization,and intracranial hemorrhage within 24 hours are the risk factors affecting the prognosis.The predictive model established by these factors has good diagnostic efficacy.Multivariate analysis can be used as an important predictor of prognosis in patients with AIS-LVO treated by MT.