急性前循环大血管闭塞机械取栓术术后患者发生恶性脑水肿的影响因素及其预测价值

Influencing factors for the occurrence of malignant cerebral edema in patients after mechanical thrombectomy for acute anterior circulation large vessel occlusion and their predictive values

目的 探讨急性前循环大血管闭塞(LVO)机械取栓术(MT)术后患者发生恶性脑水肿(MCE)的影响因素及其预测价值。方法 回顾性分析因急性前循环LVO行MT治疗的190例患者的临床资料[年龄、性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、梗死体积、术前中性粒细胞与淋巴细胞比值(NLR)、MT相关资料、术后阿尔伯塔卒中项目早期CT评分(ASPECTS)等],根据患者MT术后是否发生MCE将其分为无MCE组和MCE组。采用多因素Logistic回归模型分析急性前循环LVO MT术后患者发生MCE的影响因素,并绘制受试者工作特征(ROC)曲线分析影响因素对急性前循环LVO MT术后患者发生MCE的预测价值。结果 急性前循环LVO MT术后患者MCE的发生率为30.53%(58/190)。单因素分析结果显示,两组患者的年龄、术前NIHSS评分、梗死体积、术前NLR、侧支循环代偿良好占比、术后ASPECTS差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前NIHSS评分、梗死体积、术前NLR、术后ASPECTS是急性前循环LVO MT术后患者发生MCE的影响因素(P<0.05)。术前NIHSS评分、梗死体积、术前NLR、术后ASPECTS联合预测急性前循环LVO MT术后患者发生MCE的曲线下面积为0.936,大于四者单独预测的曲线下面积(P<0.05)。结论 急性前循环LVO MT术后患者MCE发生率较高,术前NIHSS评分高、梗死体积大、术前NLR高及术后ASPECTS高的急性前循环LVO患者MT术后更容易发生MCE,术后ASPECTS联合术前NIHSS评分、梗死体积、术前NLR对急性前循环LVO MT术后患者发生MCE具有较高的预测价值。

Objective To explore the influencing factors for the occurrence of malignant cerebral edema(MCE)in patients after mechanical thrombectomy(MT)for acute anterior circulation large vessel occlusion(LVO)and their predictive values.Methods The clinical data,namely,age,gender,preoperative National Institutes of Health Stroke Scale(NIHSS)score,infarct volume,preoperative neutrophils‐to‐lymphocytes ratio(NLR),data related to MT,and postoperative Alberta Stroke Program Early CT Score(ASPECTS)etc.,of 190 patients receiving MT for acute anterior circulation LVO were retrospectively analyzed.Patients were assigned to non‐MCE group or MCE group according to the presence of MCE after MT.The multivariate Logistic regression model was employed to analyze the influencing factors for patients suffering from MCE after MT for acute anterior circulation LVO,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive values of the influencing factors for patients suffering from MCE after MT for acute anterior circulation LVO.Results The incidence rate of MCE in patients after MT for acute anterior circulation LVO was 30.53%(58/190).The results of univariate analysis revealed that there were statistically significant differences in age,preoperative NIHSS score,infarct volume,preoperative NLR,the proportion of favorable collateral circulation compensation,postoperative ASPECTS between the two groups(P<0.05).The results of multivariate Logistic regression analysis indicated that preoperative NIHSS score,infarct volume,preoperative NLR,postoperative ASPECTS were the influencing factors for the occurrence of MCE in patients after MT for acute anterior circulation LVO(P<0.05).Area under the curve of preoperative NIHSS score,infarct volume,preoperative NLR,postoperative ASPECTS for jointly predicting patients suffering from MCE after MT for acute anterior circulation LVO was 0.936,which was larger than that of single prediction of the four(P<0.05).Conclusion The incidence rate of patients suffering from MCE after MT for acute anterior circulation LVO is relatively high.Acute anterior circulation LVO patients with high preoperative NIHSS score,large infarct volume,high preoperative NLR,and high postoperative ASPECTS easily suffer from MCE after MT.Postoperative ASPECTS combined with preoperative NIHSS score,infarct volume,preoperative NLR have relatively high predictive values on patients suffering from MCE after MT for acute anterior circulation LVO.