[1]刘钦晨,贾振宇,赵林波,等.梗死核心容积预测急性前循环大血管闭塞患者机械取栓术后出血转化的价值[J].介入放射学杂志,2021,30(08):756-760.
 LIU Qinchen,JIA Zhenyu,ZHAO Linbo,et al.The clinical value of infarction core volume in predicting hemorrhagic transformation in patients with acute anterior circulatory large vessel occlusion after receiving mechanical thrombectomy[J].journal interventional radiology,2021,30(08):756-760.
点击复制

梗死核心容积预测急性前循环大血管闭塞患者机械取栓术后出血转化的价值()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年08
页码:
756-760
栏目:
神经介入
出版日期:
2021-08-25

文章信息/Info

Title:
The clinical value of infarction core volume in predicting hemorrhagic transformation in patients with acute anterior circulatory large vessel occlusion after receiving mechanical thrombectomy
作者:
刘钦晨 贾振宇 赵林波 曹月洲 周春高 施海彬 刘 圣
Author(s):
LIU Qinchen JIA Zhenyu ZHAO Linbo CAO Yuezhou ZHOU Chungao SHI Haibin LIU Sheng.
Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210029, China
关键词:
【关键词】 急性缺血性脑卒中 机械取栓术 出血转化 梗死核心容积
文献标志码:
A
摘要:
【摘要】 目的 探讨急性前循环大血管闭塞患者机械取栓术后梗死核心容积与出血转化(HT)的关系。 方法 回顾性分析2019年10月至2020年2月在南京医科大学第一附属医院接受机械取栓术治疗前循环大血管闭塞的急性缺血性脑卒中(AIS)患者临床和影像学资料。根据欧洲急性脑卒中协作研究(ECASS)Ⅱ标准,将患者分为HT组和Non-HT组,同时根据术后是否发生实质性血肿(PH)分为PH组和Non-PH组,分别比较两组患者临床资料。采用多因素logistic回归分析评估HT和PH独立危险因素,受试者工作特征曲线(ROC)分析梗死核心容积预测HT和PH的效能。 结果 共76例患者纳入分析。HT组26例, Non-HT组50例;PH组10例,Non-PH组66例。HT组梗死核心容积、美国国立卫生研究院卒中量表(NIHSS)评分及血糖水平均高于Non-HT组(P<0.05)。PH组梗死核心容积、NIHSS评分均高于Non-PH组(P<0.05)。多因素logistic回归分析显示,梗死核心容积较大是机械取栓术后发生HT的独立危险因素(OR=1.032,95%CI=1.003~1.061, P=0.028),也是发生PH的独立危险因素(OR=1.045,95%CI=1.007~1.085,P=0.021)。梗死核心容积预测HT的灵敏度为57.7%,特异度为72.0%,ROC曲线下面积(AUC)为0.658,预测值为13.5 mL;预测PH的灵敏度为54.5%,特异度为93.8%,AUC为0.755,预测值为36 mL。 结论 梗死核心容积较大是AIS患者机械取栓术后发生HT、PH的独立危险因素。梗死核心容积对AIS患者取栓术后HT具有预测价值。

参考文献/References:

[1] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51:666- 682.
[2] Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2018, 49: E46-E110.
[3] Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med, 2015, 372: 2296-2306.
[4] 吕 军,逯党辉,李 晋,等. 急性缺血性卒中Solitaire AB支架取栓术后颅内出血并发症分析[J]. 介入放射学杂志, 2017, 26:390-393.
[5] Langel C, Popovic KS. Infarct- core CT perfusion parameters in predicting post-thrombolysis hemorrhagic transformation of acute ischemic stroke[J]. Radiol Oncol, 2018, 53:25-30.
[6] Suh CH, Jung SC, Cho SJ, et al. Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta- analysis[J]. Eur Radiol, 2019, 29: 4077- 4087.
[7] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性脑梗死后出血转化诊治共识2019[J]. 中华神经科杂志, 2019, 52:252-265.
[8] 刘 鸣. 急性脑梗死后出血转化诊断与处理[J]. 中华神经科杂志, 2020, 53:213-216.
[9] 陈艳超,雷春艳,刘 鸣. 脑梗死后出血转化不同亚型与预后关系的系统评价[J]. 中国卒中杂志, 2015, 10:827-834.
[10] Souza LC, Payabvash S, Wang Y, et al. Admission CT perfusion is an independent predictor of hemorrhagic transformation in acute stroke with similar accuracy to DWI[J]. Cerebrovasc Dis, 2012, 33: 8-15.
[11] 徐慈航,李敬伟,朱晓蕾. 急性缺血性卒中出血转化的研究进展[J]. 中国卒中杂志, 2020, 15:446- 451.
[12] Li Y, Xia Y, Chen H, et al. Focal low and global high permeability predict the possibility, risk, and location of hemorrhagic transformation following intra-arterial thrombolysis therapy in acute stroke[J]. AJNR Am J Neuroradiol, 2017, 38: 1730-1736.
[13] Yassi N, Parsons MW, Christensen S, et al. Prediction of poststroke hemorrhagic transformation using computed tomography perfusion[J]. Stroke, 2013, 44: 3039-3043.
[14] 孙 凡,刘 恒,付慧霄,等. 急性脑梗死后出血转化的危险因素[J]. 中国老年学杂志, 2019, 39:4163-4165.
[15] Tan S, Wang D, Liu M, et al. Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis[J]. J Neurol, 2014, 261: 905- 912.
[16] Rao V, Christensen S, Yennu A, et al. Ischemic core and hypo- perfusion volumes correlate with infarct size 24 hours after randomization in DEFUSE 3[J]. Stroke, 2019, 50: 626- 631.
[17] Austein F, Riedel C, Kerby T, et al. Comparison of perfusion CT software to predict the final infarct volume after thrombectomy[J]. Stroke, 2016, 47: 2311-2317.
[18] Lee YB, Yoon W, Lee YY, et al. Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions[J]. J Neurointerv Surg, 2019, 11: 469- 473.

相似文献/References:

[1]王慧晓,徐永康,张剑平,等. 机械辅助动脉内溶栓治疗急性缺血性脑卒中[J].介入放射学杂志,2012,(08):664.
 WANG Wei- xiao,XU Yong- kang,ZHANG Jian- pin,et al. Mechanical auxiliary arterial thrombolytic therapy for the treatment of acute ischemic stroke[J].journal interventional radiology,2012,(08):664.
[2]张红梅,李天晓,蒯 洁,等. 采用Solitaire支架取栓术治疗急性缺血性脑卒中的手术配合[J].介入放射学杂志,2013,(10):868.
 ZHANG Hong? mei,LI Tian? xiao,KUAI Jie,et al. Nursing cooperation with the performance of Solitaire stenting removal of thrombus for the treatment of acute ischemic stroke[J].journal interventional radiology,2013,(08):868.
[3]周腾飞,朱良付,李天晓.影响急性缺血性脑卒中血管内治疗预后的相关因素分析[J].介入放射学杂志,2017,(02):99.
 ZHOU Tengfei,ZHU Liangfu,LI Tianxiao.Analysis of factors influencing the prognosis of patients with acute ischemic stroke receiving endovascular treatment[J].journal interventional radiology,2017,(08):99.
[4]许岗勤,王子亮,汪勇锋,等.导丝留置技术在急性脑动脉闭塞机械取栓中的应用[J].介入放射学杂志,2017,(03):202.
 XU Gangqin,WANG Ziliang,WANG Yongfeng,et al.The application of indwelling guide-wire technique in performing mechanical thrombectomy for acute cerebral artery occlusion[J].journal interventional radiology,2017,(08):202.
[5]蒋文贤,齐 立,唐永刚,等.颅内血栓抽吸系统联合可视性取栓支架治疗颅内大动脉急性梗死5例 [J].介入放射学杂志,2017,(11):971.
 JIANG Wenxian,QI Li,TANG Yonggang,et al.Intracanial thrombus suction combined with visible thrombectomy stent for the treatment of acute intracranial main artery infarction: preliminary results of 5 cases[J].journal interventional radiology,2017,(08):971.
[6]尚 凯,张晓星,魏小二,等.毛细血管指数评分在CTA评估急性缺血性脑卒中侧支循环和预后中的应用[J].介入放射学杂志,2019,28(10):930.
 SHANG Kai,ZHANG Xiaoxing,WEI Xiaoer,et al.The application of capillary index core in CTA evaluation of the collateral circulation and prognosis of acute ischemic stroke[J].journal interventional radiology,2019,28(08):930.
[7]刘强,王永利,王征宇,等.动静脉联合灌注替罗非班在非大血管闭塞急性缺血性脑卒中患者中的应用[J].介入放射学杂志,2019,28(12):1131.
 LIU Qiang,WANG Yongli,WANG Zhengyu,et al.The application of intravenous and intra- arterial combined perfusion of tirofiban in treating acute ischemic stroke patients with no large vessel occlusion[J].journal interventional radiology,2019,28(08):1131.
[8]邱 凯,施海彬,祖庆泉,等.急性缺血性脑卒中机械取栓后大面积脑梗死发生及其影响因素分析[J].介入放射学杂志,2020,29(12):1182.
 QIU Kai,SHI Haibin,ZU Qingquan,et al.The occurrence of large hemispheric infarction after endovascular thrombectomy for acute ischemic stroke and its influencing factors: a clinical analysis[J].journal interventional radiology,2020,29(08):1182.
[9]陆小小,许 磊,苏浩波,等.急性缺血性脑卒中桥接治疗临床效果及预后影响因素探讨[J].介入放射学杂志,2021,30(06):595.
 LU Xiaoxiao,XU Lei,SU Haobo,et al.The curative effect of bridging therapy for acute ischemic stroke and the discussion on the prognostic factors[J].journal interventional radiology,2021,30(08):595.
[10]杭 宇,王绍显,贾振宇,等.对比剂连续应用对颅内大血管闭塞患者肾功能影响的前瞻性研究[J].介入放射学杂志,2021,30(11):1091.
 HANG Yu,WANG Shaoxian,JIA Zhenyu,et al.The effect of continuous use of iodinated contrast agent on the renal function in patients with occlusion of intracranial large artery: a prospective study[J].journal interventional radiology,2021,30(08):1091.

备注/Memo

备注/Memo:
 (收稿日期:2020-08-24)
(本文编辑:边 佶)
更新日期/Last Update: 2021-08-18