| 摘要: |
| 摘要 目的：探讨急性大血管闭塞性脑卒中患者桥接间隔时间对预后预测作用。
方法：回顾性分析厦门大学附属东南医院2022年1月至2023年12月收治急性大血管闭塞性脑卒中（aucte iachemic stroke with large vessel occlusion,AIS-LVO）患者127例为试验集，另收集2024年1月至2024年12月AIS-LVO患者71例为验证集，所有患者均接受静脉溶栓桥接机械取栓治疗，验证集中根据治疗后90天改良Rankin量表评分（mRS）评分0～2分为预后良好组（n=69）、mRS评分>2分为预后不良组（n=58），绘制受试工作者曲线分析桥接治疗间隔时间对急性大血管闭塞性脑卒中患者预后的预测效能，采用单因素和Logistic多因素分析性大血管闭塞性脑卒中患者预后影响因素，并建立风险预测模型，在验证集中验证预测模型的效能。结果：试验集中127例AIS-LVO患者ROC曲线分析发现，桥接治疗间隔时间预测预后曲线下面积（AUC）为0.834，间隔时间最佳预测界值为43 min，P<0.001；单因素分析发现，与预后良好组相比，预后不良组治疗前NIHSS评分更高、治疗前GCS评分和血管再通率更低、发病至就诊间隔时间和桥接治疗间隔时间更长、并发症发生率更高，差异有统计学意义（P<0.05）；多因素分析发现，治疗前GCS评分（95%CI：1.074～6.784，OR：2.669，P=0.035）、发病至就诊间隔时间（95%CI：0.713～0.922，OR：0.811，P=0.001）、桥接治疗间隔时间≥43 min（95%CI：3.941～73.407，OR：40.487，P<0.001）、并发症（95%CI：1.120～68.682，OR：57.657，P=0.044）是AIS-LVO患者预后独立影响因素；根据多因素分析结果，建立预后预测风险模型为F=-10.735+2.669×治疗前GCS评分-0.811×发病至就诊间隔时间+40.487×桥接治疗间隔时间（≥43 min=1、<43 min=0）+57.657×并发症（有=1、无=0）。风险模型在验证集中预测预后曲线下面积（AUC）为0.805，灵敏度0.730，特异度0.824,95%CI为0.703～0.908，P<0.001。验证集中桥接治疗间隔时间≥43 min预测预后曲线下面积（AUC）为0.801，灵敏度0.838，特异度0.765，95%CI为0.639～0.910，P<0.001。结论：对于AIS-LVO患者，桥接治疗间隔时间≥43 min对预后具有预测作用，并且是预后的独立危险因素。 |
| 关键词: 急性大血管闭塞性脑卒中 静脉溶栓 机械取栓 桥接治疗 时间 预后 |
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| Prognosis prediction and validation analysis of bridging treatment interval for acute great vascular occlusive stroke |
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韩玉惠, jianghua, xuda, yangyaling
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The 909th Hospital(Dongnan Hospital of Xiamen University)
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| Abstract: |
| Abstract Objective：To investigate the prognostic effect of bridging interval time on acute great vascular occlusive stroke patients.
Methods:A total of 127 patients with aucte iachemic stroke with large vessel occlusion (AIS-LVO) admitted to Southeast Hospital Affiliated to Xiamen University from January 2022 to December 2023 were retrospectively analyzed as the study set.71 patients with AIS-LVO from January 2024 to December 2024 were collected as a validation set.All patients were treated with intravenous thrombolytic bridging mechanical thrombectomy.In the validation set, the patients were divided into good prognosis group (n=69) and poor prognosis group (n=58) according to the modified Rankin Scale (mRS) score 0-2 at 90 days after treatment.The authors' curves was drawn to analyze the predictive efficacy of bridging treatment interval in patients with acute great vascular occlusive stroke.The prognostic factors of patients with large vascular occlusive stroke were analyzed by univariate and Logistic multivariate analysis. The risk prediction model was established according to the influencing factors, and the effectiveness of the prediction model was verified in the verification set.Results:ROC curve analysis of 127 AIS-LVO patients in the trial set showed that the area under the prognosis curve (AUC) of the bridge treatment interval was 0.834, and the best predictive threshold of the interval was 43 min (P<0.001).Univariate analysis showed that compared with the good prognosis group, the poor prognosis group had higher NIHSS score before treatment, lower GCS score before treatment, lower vascular revascularization rate, longer interval from onset to visit and bridging treatment, and higher complication rate, with statistical significance (P<0.05).Multivariate analysis showed that the GCS score before treatment (95%CI: 1.074～6.784, OR: 2.669, P=0.035), the interval between onset and treatment (95%CI: 0.713～0.922, OR: 0.811, P=0.001), bridging treatment interval ≥43 min (95%CI: 3.941～73.407, OR: 40.487, P<0.001), complications (95%CI: 1.120～68.682, OR: 57.657, P=0.044) were independent prognostic factors in AIS-LVO patients.According to the results of multivariate analysis, a prognostics risk model was established as F=-10.735+2.669× pre-treatment GCS score -0.811× interval between onset and treatment +40.487× bridging treatment interval (≥43 min=1, <43 min=0) +57.657× complications (with =1, without =0).The area under the curve (AUC) of the risk model in the validation set was 0.805, the sensitivity was 0.730, the specificity was 0.824, and the 95%CI was 0.703～0.908, P<0.001. It was verified that the area under the curve (AUC) predicted by centralized bridging treatment interval ≥43 min was 0.801, sensitivity was 0.838, specificity was 0.765, 95%CI was 0.639～0.910, P<0.001.Conclusions:For patients with AIS-LVO, the bridging therapy interval ≥43 min has a predictive effect on prognosis and is an independent risk factor for prognosis. |
| Key words: Acute great vascular occlusive stroke Intravenous thrombolysis Mechanical thrombectomy Bridging therapy Time Prognosis |