赣南医学院学报2024，Vol.44Issue(12) ：1201-1206.DOI:10.3969/j.issn.1001-5779.2024.12.001

脑白质损害对伴心房颤动急性大血管闭塞患者机械取栓术后功能转归的影响

Effect of white matter damage on functional outcomes after mechanical thrombectomy in patients with atrial fibrillation and acute large vessel occlusion

肖明辉 张聪 张帆 周敏 曾国勇
赣南医学院学报2024，Vol.44Issue(12) ：1201-1206.DOI:10.3969/j.issn.1001-5779.2024.12.001
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  • NSTL
  • 万方数据

脑白质损害对伴心房颤动急性大血管闭塞患者机械取栓术后功能转归的影响

Effect of white matter damage on functional outcomes after mechanical thrombectomy in patients with atrial fibrillation and acute large vessel occlusion

肖明辉 1张聪 2张帆 2周敏 2曾国勇2
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作者信息

  • 1. 万安县人民医院,江西 吉安 343800
  • 2. 南昌大学附属赣州医院/赣州市人民医院,江西 赣州 341000
  • 折叠

摘要

目的:探讨脑白质损害(White matter lesions,WML)严重程度与伴心房颤动急性前循环大血管闭塞患者机械取栓(Mechanical thrombectomy,MT)术后功能转归的关系.方法:回顾性分析2022年1月至2024年6月在南昌大学附属赣州医院就诊的伴有心房颤动的急性前循环大血管闭塞并接受机械取栓术患者临床资料,根据颅脑MRI或CT图像,分别采用Fazekas量表或van Swieten量表对WML严重程度进行评估,并将患者分为无/轻中度脑白质损害组、重度脑白质损害组.应用多因素Logistic回归模型评估脑白质损害严重程度与伴心房颤动急性大血管闭塞MT术后90 d预后的关系.结果:共纳入169例患者,无/轻中度WML组106例、重度WML组63例,86例MT术后90 d预后良好.重度WML组血脂异常史患有率、基线NIHSS评分高于无/轻中度WML组,MT术后90 d预后良好率低于无/轻中度WML组,差异均有统计学意义(P＜0.05).单因素分析结果显示,年龄、股动脉穿刺至血管再通时间、闭塞部位、基线NIHSS评分、基线SBP、sICH、重度WML与患者MT术后90 d预后相关(P＜0.05).多因素Logistic回归分析结果显示,基线NIHSS评分(OR=0.900,95%CI:0.844～0.961,P=0.002)、重度脑白质损害(OR=1.998,95%CI:1.023～3.092,P=0.043)为患者MT术后90 d预后不良的危险因素.结论:基线影像学重度WML与伴心房颤动急性前循环大血管闭塞患者MT术后90 d不良结局显著增加相关.重度WML可能有助于预测伴心房颤动急性前循环大血管闭塞患者MT术后临床预后.

Abstract

Objective:To investigate the association between the severity of white matter lesions(WML)and functional outcome after mechanical thrombectomy(MT)in patients with acute anterior circulation large vessel occlusion and atrial fibrillation.Methods:Retrospectively analyzed the clinical data of patients with acute anterior circulation large vessel occlusion accompanied by atrial fibrillation who underwent mechanical thrombectomy at Ganzhou Hospital Affiliated to Nanchang University from January 2022 to June 2024.Based on brain MRI or CT images,respectively the Fazekas scale or van Swieten scale was used to evaluate the severity of WML,and the patients were divided into no/mild to moderate white matter damage group and severe white matter damage group.A multivariate logistic regression model was used to evaluate the relationship between the severity of cerebral white matter damage and the 90 day prognosis after MT for acute large vessel occlusion with atrial fibrillation.Results:A total of 169 patients were included,including 106 patients in the no/mild to moderate WML group and 63 patients in the severe WML group.86 patients had good prognosis 90 days after MT.The severe WML group had a higher history of dyslipidemia and baseline NIHSS score than the no/mild-to-moderate WML group,and the 90 day good prognosis rate after MT was lower than the no/mild-to-moderate WML group,and the differences were statistically significant(P＜0.05).The results of univariate analysis showed that age,time from femoral artery puncture to recanalization,occlusion site,baseline NIHSS score,baseline SBP,sICH,and severe white matter damage were related to the 90-day prognosis of patients after MT(P＜0.05).The results of multivariate logistic regression analysis showed that baseline NIHSS score(OR=0.900,95%CI:0.844-0.961,P=0.002),severe white matter damage(OR=1.998,95%CI:1.023-3.092,P=0.043)were risk factors for poor prognosis 90 days after MT.Conclusion:Severe WML of baseline image is associated with poor functional outcome at 90 days after MT.Severe WML may help predict clinical outcome in patients with acute anterior circulation large vessel occlusive stroke and atrial fibrillation.

关键词

脑白质损害/急性缺血性卒中/大血管闭塞/机械取栓/心房颤动

Key words

White matter lesions/Acute ischemic stroke/Large vessel occlusive/Mechanical thrombectomy/Atrial fibrillation

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出版年

2024
赣南医学院学报
赣南医学院

赣南医学院学报

影响因子：0.622
ISSN：1001-5779
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