文章摘要
胡玥,林长纯,梁怀彬,刘建仁.缺血性脑卒中取栓后出血转化及长期预后的 影响因子分析[J].神经损伤功能重建,2021,16(8):444-447
缺血性脑卒中取栓后出血转化及长期预后的 影响因子分析
Analysis of Factors Affecting Hemorrhagic Transformation and Long-term Prognosis of AcuteIschemic Stroke Patients after Thrombectomy
  
DOI:
中文关键词: 急性缺血性脑卒中  血栓切除术  出血转化  预后  ASPECTS评分
英文关键词: acute ischemic stroke  thrombectomy  hemorrhagic transformation  prognosis  ASPECTS
基金项目:上海市教育委员 会高峰高原学科 建设计划(No. 2 0161422)
作者单位
胡玥,林长纯,梁怀彬,刘建仁 上海交通大学医 学院附属第九人 民医院神经内科 
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中文摘要:
      目的:分析急性缺血性脑卒中(AIS)患者取栓术再通后发生出血转化(HT)和长期预后不良的影响因 素。方法:收集接受取栓治疗的前循环AIS患者102例的临床资料,根据术后24 h~1周内是否发生HT和随 访1年时改良Rankin评分量表(mRS)评分,将患者分为HT组、NHT组和预后良好组、预后不良组。回顾性分 析各组临床资料,探究发生HT和长期预后不良的影响因素。结果:102例患者,纳入HT组58例、NHT组44 例,纳入预后不良组 56 例、预后良好组 46 例。单因素分析可知,HT 和 NHT 组、预后良好和预后不良组的 Alberta卒中项目早期CT评分(ASPECTS)评分差异有统计学意义(P=0.000、0.022);年龄(P=0.108)、冠心病 (P=0.061)、低密度脂蛋白(P=0.078)和术前静脉溶栓(P=0.058)可能对术后 HT 产生影响;取栓次数(P= 0.118)、到院至穿刺时间(P=0.098)和发病至穿刺时间(P=0.023)可能对长期预后产生影响;其他资料差异无 统计学差异(P>0.05)。将上述影响因素代入多元Logistic回归模型,分析结果显示,取栓前ASPECTS评分是 术后发生 HT(P=0.001, OR=0.561, 95%CI 0.393~0.700)的影响因素;取栓前 ASPECTS 评分(P=0.022, OR= 0.719, 95%CI 0.542~0.953)和发病至穿刺时间(P=0.042, OR=1.003, 95%CI 0.997~1.005)是患者长期预后不良 的影响因素。受试者工作特征曲线(ROC)曲线分析显示,取栓前ASPECTS评分对发生HT(AUC=0.736, 95% CI 0.637~0.875, P=0.000)和长期预后不良(AUC=0.630, 95%CI=0.522~0.734, P=0.025)均有一定的预测能力。 结论:取栓前ASPECTS评分是取栓再通后发生HT和预后不良的独立危险因素,ASPECTS评分越低,取栓再 通后HT发生风险越高,长期预后越差。
英文摘要:
      To analyze the factors affecting hemorrhagic transformation (HT) and long-term prognosis of acute ischemic stroke patients after thrombectomy. Methods: 102 patients with anterior circulation thrombectomy and recanalization were enrolled. According to the head CT prompting HT within 24 hours to 1 week after thrombectomy, patients were divided into HT group and NHT group. According to the scores of 1-year modified Rankin Scale (mRS), patients were divided into good prognosis group and poor prognosis group. The clinical data was retrospectively analyzed to find the factors affecting HT and long-term prognosis. Results: Of the 102 patients, 58 cases were included in the HT group, 44 cases in the NHT group and 56 cases in the poor prognosis group, 46 cases in the good prognosis group. Univariate analysis showed that the early Alberta Stroke Program Early CT Score (ASPECTS) in the HT and NHT groups, and in the good prognosis and poor prognosis groups were significantly different (P=0.000, 0.022). Age (P=0.108), coronary heart disease (P=0.061), low-density lipoprotein (LDL) (P=0.078) and preoperative intravenous thrombolysis (P=0.058) may have an impact on postoperative HT. The times of thrombectomy (P=0.118), the time from hospital arrival to puncture (P=0.098) and the time from onset to puncture (P=0.023) may have an impact on the long-term prognosis. Logistic regression analysis showed that the ASPECTS score before thrombus removal is the influencing factor for postoperative HT (P=0.001, OR=0.561, 95% CI 0.393~0.700); the number of thrombectomy (P=0.118), the time from hospital arrival to puncture (P= 0.098) and the time from onset to puncture (P=0.023) may have an impact on the long-term prognosis. The receiver operating characteristic curve (ROC) curve analysis showed that the ASPECTS score before thrombus removal has an effect on the occurrence of HT (AUC=0.736, 95%CI 0.637~0.875, P=0.000) and poor long-term prognosis (AUC=0.630, 95%CI= 0.522~0.734, P=0.025). Conclusion: The ASPECTS score before thrombectomy is an independent risk factor for HT and poor prognosis after thrombectomy. The lower the ASPECTS score, the higher the risk of HT after thrombectomy and the worse the long-term prognosis.
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