THRIVE评分、NLR值、D-二聚体与急性脑梗死取栓患者预后的相关性OACSTPCD
Correlation of THRIVE score,NLR,and D-dimer with prognosis in patients undergoing thrombectomy for acute ischemic stroke
目的 分析取栓术前血管事件健康风险(THRIVE)评分联合中性粒细胞-淋巴细胞百分比(NLR)、D-二聚体与缺血性脑卒中取栓术(EVT)后预后的相关性,以及预测不良结局价值.方法 回顾性连续纳入了前循环取栓治疗的165例患者临床资料,并以90 d的改良Rankin量表(mRS)评分进行分组,其中mRS评分0～3为结局良好组,mRS评分4～6为结局不良组.主要指标是在取栓术后90 d内的mRS评分,次要指标包括术后3 d内出现症状性颅内出血和(或)恶性脑水肿(MCE)以及术后30 d内病死率.采用单因素和多因素logistic回归模型来探讨相关因素,并使用受试者工作特征(ROC)曲线来分析这些因素对不良结局预测价值.结果 在结局不良组中,年龄、基线美国国立卫生研究院卒中量表(NIHSS)评分、DSA-侧支循环、THRIVE评分、NLR值和D-二聚体等因素差异有统计学意义(P＜0.05).多因素logistic回归模型分析显示,基线NIHSS评分、DSA-侧支循环、THRIVE评分、术前NLR和D-二聚体与取栓术后不良结局相关(P＜0.05).ROC曲线下面积的分析结果显示,基线NIHSS曲线下面积为0.829,THRIVE评分曲线下面积为0.768,NLR曲线下面积为0.921,D-二聚体评分曲线下面积为0.732.当联合THRIVE评分、术前NLR和D-二聚体时,ROC曲线下面积达到最大值为0.957(95％CI:0.929～0.985,P=0.000),差异均有统计学意义(P＜0.05).结论 THRIVE评分、术前NLR值、D-二聚体与缺血性脑卒中取栓术后不良结局密切相关,基线NIHSS评分和DSA-侧支循环也是影响术后不良结局的独立危险因素.联合应用THRIVE评分、术前NLR值和D-二聚体能够有效预测不良预后,并具有指导临床实践的重要意义.
Objective To analyze the correlation between pre-thrombectomy THRIVE score,neutrophil-lym-phocyte ratio(NLR),and D-dimer levels with the prognosis of patients undergoing endovascular treatment(EVT)for a-cute ischemic stroke,and to explore their predictive value for adverse outcomes.Methods A retrospective study was conducted on the clinical data of 165 patients who underwent anterior circulation thrombectomy.Patients were categorized based on their 90-day modified Rankin Scale(mRS)scores into a good outcome group(mRS 0-3)and a poor outcome group(mRS 4-6).The primary outcome was the mRS score at 90 days post-thrombectomy,while secondary outcomes included symptomatic intracranial hemorrhage and/or malignant cerebral edema(MCE)within 3 days post-surgery,and 30-day mortality rate.Univariate and multivariate logistic regression models were used to identify related factors,and re-ceiver operating characteristic(ROC)curves were used to analyze the predictive value of these factors for adverse out-comes.Results In the poor outcome group,age,baseline NIH Stroke Scale(NIHSS)scores,DSA-collateral circula-tion,THRIVE scores,NLR values,and D-dimer levels were significantly different compared to the good outcome group(P＜0.05).Multivariate logistic regression analysis indicated that baseline NIHSS scores,DSA-collateral circulation,THRIVE scores,preoperative NLR,and D-dimer levels were associated with poor outcomes post-thrombectomy(P＜0.05).The area under the ROC curve(AUC)for baseline NIHSS,THRIVE scores,NLR,and D-dimer were 0.829,0.768,0.921,and 0.732,respectively.When combining THRIVE score,preoperative NLR,and D-dimer,the AUC increased to 0.957(95％CI:0.929-0.985,P=0.000),showing a statistically significant difference(P＜0.05).Conclusion THRIVE score,preoperative NLR,and D-dimer levels are closely related to adverse outcomes following EVT for acute ischemic stroke.Baseline NIHSS scores and DS A-collateral circulation are also independent risk factors for poor outcomes.The combined use of THRIVE scores,preoperative NLR,and D-dimer levels provides effective pre-diction of adverse prognoses,offering significant guidance for clinical practice.
梁炳松;张岐平;李育英;李健;陈英道
广西医科大学第七附属医院神经内科(广西梧州 543001)
临床医学
血管取栓术血管事件健康风险评分中性粒细胞-淋巴细胞百分比D-二聚体不良结局
thrombectomyvascular event health risk scoreneutrophil-lymphocyte percentageD-dimeradverse outcome
《广东医学》 2024 (006)
757-762 / 6
广西壮族自治区卫生健康委员会科研课题(Z20211202);梧州市卫生健康委员会科研课题(WZWS-G2022011)
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