摘要
目的探讨大血管闭塞性脑梗死的血栓成分与患者脑卒中病因、机械取栓过程、血管开通程度及临床预后等的关系。方法将南京医科大学附属淮安第一医院神经内科自2018年1月至2020年1月进行支架取栓和(或)导管吸栓并成功取出血栓及行病理检查的138例急性大血管闭塞性脑梗死患者,按照血栓标本的主要成分分成红细胞为主组与纤维蛋白为主组。比较2组患者间基线临床特征、手术时间、取栓次数、血管开通程度及临床预后等资料的差异,以及分析血栓标本中红细胞浸润程度(红细胞占比)、纤维蛋白浸润程度(纤维蛋白占比)与手术时间的相关性。结果血栓标本的成分主要为红细胞、纤维蛋白、白细胞和血小板,其中59例患者的血栓成分以红细胞为主,79例患者以纤维蛋白为主。2组患者间年龄、性别、术前美国国立卫生研究院卒中量表(NIHSS)评分、高血压比例、糖尿病比例及血管成功开通比例等差异均无统计学意义(P>0.05);但与红细胞为主组比较,纤维蛋白为主组患者中心源性栓塞型比例明显更高(54.2%vs.77.2%),取栓次数明显更多[2(1,2)次vs.3(2,4)次],手术时间明显更长[45(30,60)min vs.80(60,90)min],术后90 d改良Rankin量表(mRS)评分≤2分者比例明显更低(62.7%vs.39.2%),差异均有统计学意义(P<0.05)。相关性分析发现:手术时间长短与红细胞浸润程度呈负相关关系(r=-0.562,P=0.005),与纤维蛋白浸润程度呈正相关关系(r=0.567,P=0.010)。结论不同的血栓成分提示脑卒中病因可能不同,血栓成分以红细胞为主的患者取栓相对容易,临床预后相对较好。
Objective To investigate the relations of thrombotic components with cause of stroke,procedure of mechanical thrombectomy,degrees of vascular recanalization and clinical prognoses in patients with large vessel occlusive cerebral infarction.Methods One hundred and thirty-eight patients with large vessel occlusive cerebral infarction accepted mechanical thrombectomy using stent retriever and/or aspiration catheter in our hospital from January 2018 to January 2020 were chosen.These patients were divided into two groups,a erythrocyte-rich group and a fibrin-rich group,based on the predominant composition in the clots.The baseline clinical data,procedure time,number of recanalization maneuvers,degrees of vascular recanalization and clinical prognoses were compared between the two groups.The relations of infiltration degrees of erythrocytes and fibrin in embolus with procedure time were investigated.Results The components of thrombus clots were mainly erythrocytes,fibrin,leukocytes,and platelets;erythrocyte-rich clots were presented in 59 patients,and fibrin-rich clots were presented in 79 patients.There was no significant difference in age,gender,preoperative NIHSS scores,proportions of hypertension,proportion of diabetes and proportion of vascular recanalization between the two groups(P>0.05).As compared with patients from erythrocyterich group,patients in the fibrin-rich group had significantly higher proportion of cardioembolic thrombus(22.8%vs.77.2%),statically larger number of recanalization maneuvers(2[1,2]times vs.3[2,4]times),significantly longer procedure times(45[30,60]min vs.80[60,90]min),and significantly lower proportion of patients with modifed Rankin scale(mRS)scores≤290 d after surgery(62.7%vs.39.2%,P<0.05).Procedure time was negatively correlated with erythrocyte infiltration(r=-0.562,P=0.005)and positively correlated with fibrin infiltration(r=0.567,P=0.010).Conclusions Different components of thrombus suggest the etiology of stroke may be different.Thrombus removal is relatively easy in patients w
作者
赵卫东
倪小宇
吴健
徐长松
吴嶛
左鹏
倪贵华
Zhao Weidong;Ni Xiaoyu;Wu Jian;Xu Changsong;Wu Liao;Zuo Peng;Ni Guihua(Department of Neurology,Huaian First Hospital Affiliated to Nanjing Medical University,Huaian 223200,China;Department of Pathology,Huaian First Hospital Affiliated to Nanjing Medical University,Huaian 223200,China)
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2020年第11期1122-1127,共6页
Chinese Journal of Neuromedicine
关键词
大血管闭塞性脑梗死
血栓成分
临床资料
Large-vessel occlusive cerebral infarction
Thrombus composition
Clinical data
