摘要
目的探讨急性缺血性卒中患者获得首次完全再通后不良预后的影响因素并建立列线图模型。方法回顾性分析2020年1月至2023年1月南通大学附属医院卒中中心(38例)和苏州大学附属第一医院介入科(60例)接受机械取栓治疗并获得首次完全再通的98例急性大血管闭塞性缺血性卒中患者的临床资料。根据术后90 d的改良Rankin量表评分(mRS),98例患者分为预后良好(mRS为0~2分)组和预后不良(mRS为3~6分)组。比较两组间的临床资料,并将其中差异具有统计学意义(P<0.05)者纳入多因素logistic回归模型分析,筛选患者不良预后的独立影响因素并构建列线图模型,通过受试者工作特征(ROC)曲线图、校准图分析列线图模型预测患者不良预后的性能。结果98例患者中,预后良好组44例,预后不良组54例。单因素分析结果显示,两组患者的年龄、美国国立卫生研究院卒中量表(NIHSS)评分、阿尔伯塔卒中项目早期CT评分(ASPECTS)、缺血半暗带体积、血栓负荷量得分(CBS)>6分患者的比例、区域软脑膜侧支(rLMC)分级、血清中性粒细胞计数、血清中性粒细胞与淋巴细胞比值(NLR)、血清血小板计数、采用局部麻醉的患者比例、出血转化比例的差异均存在统计学意义(均P<0.05)。多因素logistic回归模型分析结果显示,年龄偏高(OR=0.94,95%CI:0.89~0.99,P=0.037)、入院时高NIHSS评分(OR=0.86,95%CI:0.77~0.97,P=0.010)、高NLR(OR=0.88,95%CI:0.77~0.99,P=0.045)、较差的侧支循环状态(OR=0.03,95%CI:0.00~0.24,P=0.001)均为获得首次完全再通的急性缺血性卒中患者不良预后的独立影响因素。根据上述独立影响因素建立的预测模型的ROC曲线下面积为0.90(95%CI:0.84~0.96)。结论根据患者的年龄、入院时NIHSS评分、NLR、侧支循环状态构建的列线图模型可能能够预测急性缺血性卒中患者获得首次完全再通后不良预后的概率。
Objectives To investigate the risk factors for poor outcome in patients with acute ischemic stroke(AIS)who obtained first-pass complete recanalization(FPCR),to construct a nomogram model with early prediction value.Methods Clinical data of patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)who underwent mechanical thrombectomy and obtained FPCR from January 2020 to January 2023 in the Stroke Centre of the Affiliated Hospital of Nantong University(38 patients)and the Department of Interventional Radiology of the First Affiliated Hospital of Soochow University(60 patients)were retrospectively analyzed.According to 90-day modified Rankin scale(mRS)score,98 patients were divided into favorable outcome group(mRS of 0-2)and unfavorable outcome group(mRS of 3-6).The general information,laboratory examination indexes,imaging examination indexes and operation information of patients in the two groups were compared.The items with statistically significant differences(P<0.05)were included in multivariate logistic regression analysis to identify the independent factors related to unfavorable outcome and construct a nomogram model.The performance of the nomogram was verified by the receiver operating characteristic(ROC)and calibration chart respectively.Results There were 44 cases in favorable outcome group and 54 cases in unfavorable outcome group.The results of univariate analysis demonstrated that the observed differences between the two groups in terms of age,National Institute of Health stroke scale(NIHSS)score,Alberta stroke program early computed tomography score(ASPECTS),proportion of patients with clot burden score(CBS)>6,high regional leptomeningeal collateral(rLMC)grading,neutrophil count,neutrophil-to-lymphocyte ratio(NLR),platelet count,proportion of patients with local anesthesia,and proportion of hemorrhage transformation were statistically significant(all P<0.05).Multivariate logistic regression analysis showed that older age(OR:0.94,95%CI:0.89-0.99,P=0.037),high NIHSS scores at admission(
作者
陈正文
贾琪
邵俊杰
王竞立
郁超
丁运
陈珑
卢小健
Chen Zhengwen;Jia Qi;Shao Junjie;Wang Jingli;Yu Chao;Ding Yun;Chen Long;Lu Xiaojian(Department of Stroke Centre of Nantong University Hospital,Nantong 226001,China;Department of Interventional Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2024年第9期929-935,共7页
Chinese Journal of Neurosurgery
基金
江苏省医学会介入医学专项基金[SYH-3201140-0087(2023034)]。
关键词
卒中
血管内操作
预后
首次完全再通
列线图
预测
Stroke
Endovascular procedures
Prognosis
First-pass complete recanlization
Nomogram model
Forecasting
