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中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 319 -322. doi: 10.11817/j.issn.1673-9248.2021.05.009

论著

前循环串联病变血管内治疗预后的影响因素分析
彭涛1, 张紫霓1, 朱碧峰1, 但毕堂1,†()   
  1. 1. 430000　武汉，江汉大学附属湖北省第三人民医院神经内科
  • 收稿日期:2020-08-18 出版日期:2021-10-09
  • 通信作者: 但毕堂

Factors affecting the prognosis of endovascular treatment for anterior circulation tandem lesions

Tao Peng1, Zini Zhang1, Bifeng Zhu1, Bitang Dan1()   

  1. 1. Department of Neurology, Jianghan University Affiliated Third People's Hospital of Hubei Province, Wuhan 430000, China
  • Received:2020-08-18 Published:2021-10-09
  • Corresponding author: Bitang Dan
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彭涛, 张紫霓, 朱碧峰, 但毕堂. 前循环串联病变血管内治疗预后的影响因素分析[J]. 中华脑血管病杂志(电子版), 2021, 15(05): 319-322.

Tao Peng, Zini Zhang, Bifeng Zhu, Bitang Dan. Factors affecting the prognosis of endovascular treatment for anterior circulation tandem lesions[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2021, 15(05): 319-322.

目的

探讨前循环串联病变血管内治疗预后的影响因素。

方法

回顾性分析2014年1月1日至2019年12月31日湖北省第三人民医院神经内科收治的43例急性前循环串联病变患者的临床资料。按术后90 d改良Rankin量表（mRS）评分进行分组，MRS评分0~2分组为预后良好组，3~6分组为预后不良组。对于年龄、美国国立卫生院脑卒中量表评分（NIHSS）、Albert卒中计划早期CT评分（ASPECTS）和性别、高血压、糖尿病、高脂血症、冠心病、吸烟、心房颤动、静脉溶栓、颈动脉置入支架、取栓次数、血管再通情况、症状性颅内出血等资料进行分析，归纳前循环串联病变血管内治疗预后的影响因素分析。

结果

90 d良好预后组与预后不良组相比较，糖尿病及冠心病发病率更低（2/23 vs 7/20；3/23 vs 10/20），基线ASPECTS评分更高（7.61±2.06）分 vs（5.80±2.57）分，取栓次数（≤3）所占比例高（22/23 vs 10/20），差异均具有统计学意义（χ2=4.473，P=0.034；χ2=6.927，P=0.008；t=2.562，P=0.014；χ2=11.711，P＜0.001）。多因素Logistic回归分析显示冠心病（无）（OR=0.049，P=0.007）、取栓次数（≤3次）（OR=0.470，P=0.026）是预后的保护因素，基线ASPECTS评分（OR=1.470，P=0.043）是预后的影响因素。ASPECTS评分的阈值为5分，其敏感度为91.3%，特异度为55.0%，ROC曲线下面积为0.720，P=0.014，95%CI为0.564~0.876。

结论

ASPECTS评分≥5分、取栓次数≤3次、无冠心病的前循环串联病变患者有更大可能获得良好预后。

关键词: 急性缺血性卒中, 串联病变, 血管内治疗, Albert卒中计划早期CT评分, 预后
Objective

To explore the factors affecting the prognosis of endovascular treatment for anterior circulation tandem lesions.

Methods

The retrospective analysis collected the clinical data of 43 patients with acute anterior circulation tandem lesions admitted to Department of Neurology, Jianghan University Affiliated Third People's Hospital of Hubei Province from January 1, 2014 to December 31, 2019. According to the 90-day modified Rankin scale (mRS) after the operation, patients with mRS score 0-2 were defined as the good prognosis group, and patients with 3-6 as the poor prognosis group. For continuous variables such as age, National Institutes of Health Stroke Scale (NIHSS), and baseline Alberta stroke program early CT score (ASPECTS score), t test was used. Chi-square analysis was used for categorical variables such as gender, hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking, atrial fibrillation, intravenous thrombolysis, carotid stent placement, thrombectomy times, vascular recanalization, symptomatic intracranial hemorrhage. Multivariate Logistic analysis was used to evaluate the factors affecting the prognosis of endovascular treatment for anterior circulation tandem lesions.

Results

Compared with the poor prognosis group, the good prognosis group had a lower incidence of diabetes and coronary heart disease(2/23 vs 7/20, χ2=4.473, P=0.034; 3/23 vs 10/20, χ2=6.927, P=0.008), a higher baseline ASPECTS score [(7.61±2.06) vs (5.80±2.57), t=2.562, P=0.014], and fewer thrombus removals (22/23 vs 10/20; χ2=11.711, P＜0.001). Multivariate logistic regression analysis showed that no coronary heart disease (OR=0.049, P=0.007) and embolectomy ≤3 times (OR=0.470, P=0.026) were protective factors for prognosis, and baseline aspects score (OR=1.470, P=0.043) was another influence factor for prognosis (P＜0.05). The ASPECTS score threshold was 5 points, with the sensitivity of 91.3% and the specificity of 55.0%. The area under the ROC curve was 0.72 (P=0.014, 95% CI 0.564~0.876).

Conclusion

Patients with anterior circulation tandem lesions with an ASPECTS score ≥5 points, thrombectomy times ≤3 times, and no coronary heart disease are more likely to have a good prognosis.

Key words: Acute ischemic stroke, Tandem lesions, Endovascular treatment, ASPECTS score, Prognosis
表1 不同预后急性串联病变患者临床资料
组别 例数 年龄（岁，
x¯
±s）		 男/女（例） 高血压（例） 糖尿病（例） 高脂血症（例） 吸烟（例） 冠心病（例） 心房颤动（例）
良好预后 23 63.59±11.21 17/6 11 2 3 3 3 10
不良预后 20 67.05±10.1 15/5 13 7 2 6 10 9
统计值 t=-1.051 χ2=0.007 χ2=1.279 χ2=4.473 χ2=0.096 χ2=1.859 χ2=6.927 χ2=0.010
P值 0.299 0.935 0.258 0.034 0.756 0.173 0.008 0.920
组别 例数 NIHSS评分 ASPECTS评分 静脉溶栓（例） 颈动脉支架（例） 取栓次数（≤3） 良好再通（TICI≥3b） 症状颅内出血（例）
良好预后 23 18.13±4.63 7.61±2.06 10 10 22 22 0
不良预后 20 19.60±4.43 5.80±2.57 5 8 10 17 2
统计值 t=-1.060 t=2.562 χ2=1.608 χ2=0.053 χ2=11.711 χ2=1.439 χ2=2.412
P值 0.295 0.014 0.205 0.818 ＜0.001 0.230 0.120
表2 急性串联病变患者预后多因素Logistic回归分析
影响因素 β值 SE值 Wald值 P值 OR值 95%CI
糖尿病 -2.196 1.187 3.421 0.064 0.111 0.011~1.140
冠心病（无） -3.008 1.124 7.158 0.007 0.049 0.005~0.447
ASPECTS评分 0.385 0.203 3.582 0.043 1.470 1.014~2.317
取栓次数（≤3次） -0.754 0.339 4.965 0.026 0.470 0.242~0.913
常量 1.009 1.829 0.304 0.581 2.744 —
图1 ASPECTS评分预测急性串联病变患者预后的曲线
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