文章摘要
张蕾, ，张之悦, ，王爽, ，严钢莉 ，黎逢光.大血管闭塞性轻型缺血性脑卒中介入治疗的疗效与安全性观察[J].神经损伤功能重建,2024,(5):262-267
大血管闭塞性轻型缺血性脑卒中介入治疗的疗效与安全性观察
Efficacy and Safety of Interventional Therapy for Mild Ischemic Stroke Patients with LargeVessel Occlusion: an Observational Study
  
DOI：
中文关键词: 缺血性轻型卒中  介入治疗  机械取栓  颅内大血管闭塞
英文关键词: mild ischemic stroke  interventional therapy  mechanical thrombectomy  large vessel occlusion
基金项目:湖北省自然科学基 金资助项目（三嵌 段共聚物纳米胶束 包载姜黄素通过抑 制 IncRNA GAS5 调控NF-κB信号通 路减轻脑缺血损伤 的 实 验 研 究 ，No. 2021CFB585）；湖 北省卫健委资助项 目（急性大动脉粥 样硬化性脑梗死患 者 血 浆 外 泌 体 中 IncRNA 表达谱变 化及其作用机制研 究，No. WJ2021M0 30）
作者单位
张蕾1,2 ，张之悦1,2 ，王爽1,2 ，严钢莉1 ，黎逢光1 1. 武汉科技大学附 属普仁医院 2. 武汉科技大学医 学部医学院 
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中文摘要:
      目的：探讨介入治疗在大血管闭塞性轻型卒中（large vessel occlusion，LVO-MIS）患者中的安全性与 有效性，以及可能影响这类患者预后的相关因素。方法：回顾性纳入武汉科技大学附属普仁医院神经内科 2020年１月至2023年9月收治的79例LVO-MIS患者，按治疗方法分为单纯药物治疗组49例和介入治疗组 30例，主要观察指标为患者90 d时以改良Rankin量表（modified Rankin scale，mRS）评分定义的神经功能恢 复情况（mRS≤1分为预后优秀，mRS 1～2分定义为预后良好，mRS＞2分定义为预后不良），次要观察指标 为治疗后血管再通情况、早期神经功能恶化，症状性颅内出血及死亡，同时采用Logistic回归分析可能影响 LVO-MIS患者预后的因素。结果：介入组28例实现成功再通（93.3%）。治疗后90 d，介入治疗组的预后优 秀率高于单纯药物治疗组（P=0.022）。2组患者在早期神经功能恶化、症状性颅内出血及病死率间差异无 统计学意义（P＞0.05）。多因素Logistic分析结果显示，介入治疗是LVO-MIS患者术后90 d取得优秀预后 的独立保护因素（P＜0.05），而入院NIHSS评分、发病至入院时间可能是LVO-MIS患者术后90 d预后优秀 的危险因素（均P＜0.05）。结论：介入治疗对于合并大血管闭塞情况的轻型缺血性卒中患者的预后改善安 全且有效，且不会明显增加术后症状性颅内出血、死亡等不良事件风险。
英文摘要:
      To explore the safety and efficacy of intervention therapy for mild ischemic stroke patients with large vessel occlusion (LVO-MIS) and identify factors influencing the prognosis of LVO-MIS patients. Methods: Seventy-nine patients with LVO-MIS were retrospectively included from January 2020 to September 2023 at the Department of Neurology, Puren Hospital, Wuhan University of Science and Technology. They were divided into two groups based on the treatment method: 30 cases in the interventional therapy group and 49 cases in the medication-only group. The primary endpoints were the neurological recovery at day 90, assessed by the modified Rankin scale (mRS) score (mRS≤1 defined as excellent prognosis, mRS 1～2 as good prognosis, and mRS>2 as poor prognosis). Secondary outcomes included post-treatment revascularization, early neurological deterioration, symptomatic intracranial hemorrhage and mortality. Logistic regression was used to identify factors affecting the prognosis of patients with LVO-MIS. Results: Twenty-eight patients in the interventional therapy group achieved successful recanalization of blood vessels (93.3% ). At 90 days after treatment, the rate of excellent prognosis was significantly higher in the interventional therapy group than in the medication-only group (P=0.022). There were no statistically significant differences between the two groups regarding early neurological deterioration, symptomatic intracranial hemorrhage and morbidity and mortality (P> 0.05). Multivariate Logistic analysis results showed that interventional therapy (P<0.05) was an independent protective factor for achieving an excellent prognosis in LVO-MIS patients at 90 days postoperatively. Additionally, the NIHSS score at admission and time from onset to admission (all P<0.05) were independent risk factors for excellent prognosis in LVO-MIS patients at 90 days postoperatively. Conclusion: Interventional therapy is safe and effective in improving the prognosis of patients with LVO-MIS, without significantly increasing the risk of adverse events such as postoperative symptomatic intracranial hemorrhage and mortality.
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