摘要
目的通过全脑血管造影术(Digital Subtraction Angiography,DSA)评估大脑中动脉闭塞后供血区域的侧支代偿联合NIHSS评分预测患者的预后。方法采用回顾性队列研究的方法收集从2017年5月-2018年5月西北大学附属医院经DSA确诊大脑中动脉闭塞的患者;采用美国介入和治疗神经放射学学会/介入放射学学会(American Society of Interventional and Therapeutic Neuroradiology/Society of Interven-tional Radiology collateral vessel grading system,ASTIN/SIR)侧支循环评估系统进行评分并采集患者入院时NIHSS评分,然后随访患者3个月时mRS评分,采用ASTIN/SIR方法与NIHSS评分联合预测患者的预后。结果 (1)ASTIN/SIR评分与NIHSS评分相关,相关系数为-0.734,P<0.0001;(2)ASTIN/SIR评分预测患者预后不良的敏感度为92.3%特异度为66.7%,P<0.0001,95%可信区间(0.692～0.960);NIHSS评分预测患者预后不良的敏感度为100%特异度为66.1%,P<0.0001,95%可信区间(0.735～0.977);(3)ASTIN/SIR评分联合NIHSS评分预测患者预后不良的敏感度为92.8%特异度为77.8%,P<0.0001,95%可信区间(0.772～0.989)。结论 (1)ASTIN/SIR评分与NIHSS评分在大脑中动脉闭塞患者中呈负相关;(2)ASTIN/SIR评分及NIHSS评分可以预测大脑中动脉闭塞患者的预后;(3)ASTIN/SIR评分与NIHSS评分联合应用可增加预测大脑中动脉患者预后不良的特异度。
Objective To study the prognosis of patients with middle cerebral artery occlusion by collateral compensation derived from Digital Subtraction Angiography(DSA)combined with NIHSS score.Methods A retrospective cohort study was conducted to collect patients with middle cerebral artery occlusion diagnosed by DSA in Northwestern University Affiliated Hospital from May 2017 to May 2018.We used the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral vessel grading system(ASTIN/SIR)to assess collateral circulation and collected NIHSS score at admission and mRS was obtained at 3 month after stroke onset.ASTIN/SIR method combined with NIHSS score to predict the prognosis of patients.Results(1)The ASTIN/SIR score was correlated with NIHSS score,r=-0.734,P<0.0001.(2)The sensitivity of ASTIN/SIR score in predicting poor prognosis was 92.3% with specificity of 66.7% P<0.0001 95%confidence interval(0.692-0.960)and NIHSS score in predicting poor prognosis was 66.1% with specificity of 100% P<0.0001 95%confidence interval(0.735-0.977).(3)The sensitivity of ASTIN/SIR score combined with NIHSS score in predicting poor prognosis was 92.8% and the specificity was 77.8% P<0.0001 95%confidence interval(0.772-0.989).Conclusion(1)ASTIN/SIR assessment of collateral compensation and NIHSS score is negatively correlated with patients with middle cerebral artery occlusion.(2)ASTIN/SIR collateral assessment and NIHSS score can predict the prognosis of patients with middle cerebral artery occlusion.(3)ASTIN/SIR combined with NIHSS score can increase the specificity of predicting poor prognosis in patients with middle cerebral artery disease.
引文
[1]Wang,W.Prevalence,incidence,and mortality of stroke in ChinaClinical perspective:results from a nationwide PopulationBased survey of 480 687adults[J].Circulation,2017,135(8):759.
[2]Song J,Ma Z,Meng H,et al.Distal hyperintense vessels alleviate insula infarction in proximal middle cerebral artery occlusion[J].Int J Neurosci,2016,126(11):1030-1035.
[3]Nogueira RG,Jadhav AP,Haussen DC,et al.Thrombectomy 6to 24hours after stroke with a mismatch between deficit and infarct[J].N Engl J Med,2018,378(1):11-21.
[4]Albers GW,Marks MP,Kemp S,et al.Thrombectomy for stroke at 6to 16hours with selection by perfusion imaging[J].N Engl J Med,2018,378(8):708-718.
[5]Interventional TA,T.Neuroradiology,trial design and reporting standards for intraarterial cerebral thrombolysis for acute ischemic stroke[J].Journal of Vascular&Interventional Radiology,2003,14(8):E1-E31.
[6]Jr,H A.Baseline NIH stroke scale score strongly predicts outcome after stroke:a report of the trial of Org 10172in acute stroke treatment(TOAST)[J].Neurology,1999,53(1):126-131.
[7]Berkhemer OA,Fransen PS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].NEngl J Med,2015,372(1):11-20.
[8]Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].NEngl J Med,2015,372(11):1009-1018.
[9]Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].NEngl J Med,2015,372(11):1019-1030.
[10]Saver JL,Goyal M,Bonafe A,et al.Stent-Retriever thrombectomy after intravenous t-PA vs.t-PA alone in stroke[J].NEngl J Med,2015,372(24):2285-2295.
[11]Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8hours after symptom onset in ischemic stroke[J].N Engl JMed,2015,372(24):2296-2306.
[12]Singer OC,Berkefeld J,Nolte CH,et al.Collateral vessels in proximal middle cerebral artery occlusion:the ENDOSTROKEstudy[J].Radiology,2015,274(3):851-858.
[13]黄家星,林文华,刘丽萍,等.缺血性卒中侧支循环评估与干预中国专家共识[J].中国卒中杂志,2013,8(4):285-293.
[14]Liebeskind DS,Jahan R,Nogueira RG,et al.Impact of collaterals on successful revascularization in solitaire FR with the intention for thrombectomy[J].Stroke,2014,45(7):2036-2040.
[15]Liebeskind DS,Tomsick TA,Foster LD,et al.Collaterals at angiography and outcomes in the Interventional Management of Stroke(IMS)III trial[J].Stroke,2014,45(3):759-764.
[16]Heldner MR,Zubler C,Mattle HP,et al.National institutes of health stroke scale score and vessel occlusion in 2152patients with acute ischemic stroke[J].Stroke,2013,44(4):1153-1157.
[17]Kitagawa K,Yagita Y,Sasaki T,et al.Chronic mild reduction of cerebral perfusion pressure induces ischemic tolerance in focal cerebral ischemia[J].Stroke,2005,36(10):2270-2274.
