| 摘要: |
| 目的 探索前循环大血管闭塞急性缺血性脑卒中（AIS-LVO）患者行血管内治疗（EVT）后预后不良的危险因素，明确D-二聚体对前循环AIS-LVO行EVT后预后不良的预测价值。方法 选取2018年12月至2022年12月在河北省人民医院神经内科住院并行EVT的前循环AIS-LVO患者作为研究对象，根据术后90 d改良Rankin量表（mRS）评分分为预后良好组（mRS评分0～2分）和预后不良组（mRS评分3～6分）。收集研究对象的术前Alberta脑卒中计划早期计算机断层扫描评分（ASPECTS）、术前美国国立卫生研究院卒中量表（NIHSS）评分、术前格拉斯哥昏迷量表评分、术后即刻改良脑梗死溶栓（mTICI）分级、一般资料、实验室资料等，采用二元logistic回归方法分析前循环AIS-LVO患者行EVT后预后不良的影响因素，绘制ROC曲线评价D-二聚体对预后不良的预测价值。结果 共纳入143例行EVT的前循环AIS-LVO患者，其中预后不良组54例、预后良好组89例。与预后不良组相比，预后良好组患者的年龄小、糖尿病史占比低、术前NIHSS评分低、术前ASPECTS及格拉斯哥昏迷量表评分高、术后即刻mTICI分级为2b～3级的占比高、术前D-二聚体水平低，差异均有统计学意义（P均＜0.05）,二元logistic回归分析显示，术前NIHSS评分（OR=1.096，95% CI 1.007～1.193）、术后即刻mTICI分级（OR=19.609，95% CI 5.354～71.815）、术前D-二聚体水平（OR=1.310，95% CI 1.128～1.521）是前循环AIS-LVO行EVT患者预后不良的独立危险因素, D-二聚体对前循环AIS-LVO患者EVT预后不良的ROC曲线AUC为0.642（95% CI 0.540～0.745）。结论 术前NIHSS评分、术后即刻mTICI分级、术前D-二聚体水平升高是前循环AISLVO患者行EVT后预后不良的独立危险因素，术前D-二聚体水平升高的AIS-LVO患者行EVT后的预后可能较差。 |
| 关键词: 脑梗死 前循环 大动脉闭塞 血管内治疗 D-二聚体 预后 |
| DOI：10.16781/j.CN31-2187/R.20230183 |
| 投稿时间：2023-04-08修订日期：2023-09-20 |
| 基金项目:河北省医学科学研究课题（20210914, 20230293）. |
|
| Predictive value of D-dimer for poor prognosis of anterior circulation acute ischemic stroke with large-vessel occlusion after endovascular treatment |
| XIE Yanzhao*,MA Liang,HAN Ning,QI Guosong,SUN Qiang,XU Guodong* |
(Department of Neurology, Hebei General Hospital, Shijiazhuang 050000, Hebei, China
*Corresponding authors) |
| Abstract: |
| Objective To explore the risk factors of poor prognosis of anterior circulation acute ischemic stroke with large-vessel occlusion (AIS-LVO) patients after endovascular therapy (EVT), so as to determine the predictive value of D-dimer for poor prognosis of anterior circulation AIS-LVO patients after EVT. Methods Anterior circulation AIS-LVO patients who received EVT and hospitalized in the Department of Neurology, Hebei General Hospital from Dec. 2018 to Dec. 2022 were enrolled. According to the 90-d modified Rankin scale (mRS) score after operation, they were assigned to good prognosis group (mRS score of 0-2) or poor prognosis group (mRS score of 3-6). Preoperative Alberta Stroke Program early computed tomography score (ASPECTS), preoperative National Institutes of Health stroke scale (NIHSS) score, preoperative Glasgow coma scale score, immediate postoperative modified thrombolysis in cerebral infarction (mTICI) grade, general data, and laboratory data of anterior circulation AIS-LVO patients were collected. Binary logistic regression was used to analyze the influencing factors of poor prognosis in anterior circulation AIS-LVO patients after EVT, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of D-dimer for poor prognosis. Results A total of 143 patients with anterior circulation AIS-LVO undergoing EVT were enrolled, with 54 patients in the poor prognosis group and 89 in the good prognosis group. Compared with the poor prognosis group, patients in the good prognosis group had younger age, lower proportion of diabetes mellitus, lower preoperative NIHSS score, higher preoperative ASPECTS and Glasgow coma scale score,higher proportion of immediate postoperative mTICI grade 2b-3, and lower preoperative D-dimer level (all P＜0.05). Binary logistic regression analysis showed that preoperative NIHSS score (odds ratio[OR］＝1.096, 95% confidence interval[CI］ 1.007-1.193), immediate postoperative mTICI grading (OR=19.609, 95% CI 5.354-71.815) and preoperative D-dimer level (OR=1.310, 95% CI 1.128-1.521) were independent risk factors for poor prognosis in anterior circulation AIS-LVO patients receiving EVT. The area under the ROC curve value of D-dimer for the the poor prognosis of anterior circulation AIS-LVO patients after EVT was 0.642 (95% CI 0.54-0.745). Conclusion Preoperative NIHSS score, immediate postoperative mTICI grading and higher preoperative D-dimer level are independent risk factors for poor prognosis in anterior circulation AIS-LVO patients after EVT. AIS-LVO patients with elevated D-dimer levels before surgery may have a poor prognosis after EVT. |
| Key words: cerebral infarction anterior circulation large artery occlusion endovascular treatment D-dimer prognosis |
