摘要
目的探讨血管内治疗(endovascular therapy,EVT)前循环急性大血管闭塞性卒中(acute large vessel occlusion stroke,AIS-LVO)患者出血转化(hemorrhagic transformation,HT)及症状性颅内出血(symptomatic intracranial hemorrhage,sICH)的影响因素。方法纳入2023年1月至2024年11月在安阳市人民医院神经内科收治的AIS-LVO患者193例,其中HT组84例,sICH组42例。收集患者的临床资料,包括性别、年龄、血管危险因素(高血压病史、糖尿病史、冠心病史、心房颤动、冠脉支架植入术、瓣膜置换术、吸烟)、脑卒中病史、术前美国国立卫生研究院卒中量表(NIHSS)评分、实验室指标(术前D-二聚体、中性粒细胞、淋巴细胞、术后CO_(2)总量、CO_(2)分压),以及围手术期相关指标(手术时间、手术方式、麻醉方式、术前静脉溶栓情况)。比较非HT组与HT组、非sICH组与sICH组患者的临床资料,分析EVT前循环AIS-LVO后HT、sICH的独立危险因素。结果HT组与非HT组患者的冠心病(χ^(2)=8.443,P=0.004)、D-二聚体(Z=-3.59,P<0.001)、术前NIHSS评分(Z=-3.752,P<0.001)、手术时间(Z=-2.529,P=0.011)、病变部位(χ^(2)=9.951,P=0.019)及合并其他血管中重度狭窄或闭塞(P=0.025)等差异均有统计学意义。其他基线和临床资料差异均无统计学意义(P>0.05)。多因素logistic回归分析结果显示,术前NIHSS评分(OR=1.065,95%CI:1.021~1.110,P<0.003)、串联型病变(OR=2.805,95%CI:1.306~6.024,P=0.008)、冠心病(OR=2.963,95%CI:1.421~6.174,P=0.004)、手术时间(OR=1.009,95%CI:1.001~1.016,P=0.019)是EVT后HT的独立危险因素。sICH组与非sICH组的基线资料及患者闭塞部位、合并其他血管狭窄及围手术期相关指标间差异无统计学意义。结论术前NIHSS评分、串联型病变、冠心病、手术时间是前循环AIS-LVO患者EVT后HT的独立危险因素。
Objective To investigate the factors affecting the hemorrhagic transformation(HT)and symptomatic intracranial hemorrhage(sICH)in patients with acute ischemic stroke due to large vessel occlusion(AIS-LVO)of anterior circulation after receiving endovascular treatment(EVT).Methods A total of 193 patients with AIS-LVO of anterior circulation,who were admitted to the Neurology Department of Anyang Municipal People's Hospital of China from January 2023 to November 2024,were enrolled in this study.There were 84 patients in the HT group and 42 patients in the sICH group.The baseline and clinical data,including gender,age,vascular risk factors(history of hypertension,diabetes,coronary artery disease,atrial fibrillation,coronary stent implantation,valve replacement,smoking),stroke history,pre-operative National Institutes of Health Stroke Scale(NIHSS)scores,laboratory indicators(preoperative D-dimer,neutrophil count,lymphocyte count,postoperative total CO_(2),and CO_(2)partial pressure),and perioperative indicators(procedure duration,surgical approach,anesthesia type,and preoperative intravenous thrombolysis),were collected.The clinical data were compared between non-HT group and HT group,as well as between non-sICH group and sICH group,and the independent risk factors for HT and sICH after receiving EVT treatment for AIS-LVO of anterior circulation were analyzed.Results The differences in coronary heart disease(χ^(2)=8.443,P=0.004),D-dimer(Z=-3.59,P<0.001),preoperative NIHSS score(Z=-3.752,P<0.001),surgical time(Z=-2.529,P=0.011),lesion site(χ^(2)=9.951,P=0.019),and moderate to severe stenosis or occlusion of other blood vessels(P=0.025)between the HT group and the non-HT group were statistically significant.The differences in the other baseline indicators and clinical data were not statistically significant(all P>0.05).The multivariate logistic regression analysis showed that preoperative NIHSS score(OR=1.065,95%CI:1.021-1.110,P<0.003),tandem lesions(OR=2.805,95%CI:1.306-6.024,P=0.008),coronary heart disease(OR=2.963,95%CI:1.421-6.174,P=0.004),and operation time(OR=1.009,95%CI:1.001-1.016,P=0.019)were the independent risk factors for HT after EVT.No statistically significant differences in baseline data,occlusion site,coexisting other vascular stenosis,and perioperative related indicators existed between the sICH group and the non-sICH group.Conclusion Preoperative NIHSS score,tandem lesion,coronary artery disease,and operation time are the independent risk factors for HT in patients with AIS-LVO of the anterior circulation after receiving EVT.
作者
苏芳慧
许冬
童会霞
邱思峥
杨清成
SU Fanghui;XU Dong;TONG Huixia;QIU Sizheng;YANG Qingcheng(Department of Neurology,Anyang Municipal People's Hospital,Anyang,Henan Province 455100,China)
出处
《介入放射学杂志》
北大核心
2025年第11期1178-1184,共7页
Journal of Interventional Radiology
关键词
血管内治疗
急性前循环大血管闭塞
影响因素分析
出血转化
endovascular treatment
acute large vessel occlusion of anterior circulation ischemic stroke
analysis of influencing factor
hemorrhagic transformation
