毛细血管指数评分在急性前循环缺血性卒中 血管内治疗中的应用价值

Application of capillary index score in assessing prognosis of patients with acute anterior circulation ichemic stroke after endovascular treatment

摘要:

目的 探讨毛细血管指数评分（CIS）评估急性前循环缺血性卒中患者侧支循环情况，评价CIS 在急性前循环缺血性卒中血管内治疗中的价值。方法 回顾性分析2015 年2 月—2018 年12 月就诊于安庆 市第一人民医院行血管内治疗的52 例急性前循环缺血性卒中患者。纳入患者行全脑数字减影血管造影完成 CIS，分为充盈良好（fCIS 组）27 例和充盈不良（pCIS 组）25 例。根据改良Rankin 量表（mRS）评分分为 良好预后组24 例（≤ 2 分）和不良预后组28 例（>3 分）。单因素分析比较两组基线资料和临床资料，多因 素Logistic 回归分析CIS 对预后结局的影响。结果 fCIS 组与pCIS 组年龄、性别、糖尿病史、收缩压、心房 颤动、高脂血症、美国国立卫生研究院卒中量表（NIHSS）评分、发病至血管再通时间（TTR）比较，差异 无统计学意义（P >0.05），而扩散加权成像Alberta 卒中早期CT 评分（DWI-ASPECTS）、改良脑梗死溶栓实 验分级（mTICI）≥Ⅱ b 患者比例比较，差异有统计学意义（P <0.05）。良好预后组与不良预后组年龄、性 别、糖尿病史、收缩压、心房颤动、高脂血症、NIHSS 评分、TTR 比较，差异无统计学意义（P >0.05），而 DWI-ASPECTS 评分、≥Ⅱ b 及fCIS 比较，差异有统计学意义（P <0.05）。多因素Logistic 回归分析显示， mTICI[Ol ^ R=5.603（95% CI ：2.035，21.447）] 和DWI-ASPECTS 评分[Ol ^ R=0.625（95% CI ：0.472，0.826）] 是血管内治疗预后的危险因素，而CIS[Ol ^ R=8.474（95% CI ：2.478，32.516）] 是其保护因素。结论 CIS 可 用于评价脑组织灌注及毛细血管充盈情况，在EVT 时增加CIS 和DWI-ASPECT 评分评价，对预测急性缺血 性脑卒中患者的预后具有重要价值。

Abstract:

Objective To evaluate the ability of capillary index score (CIS) to evaluate collateral circulation in patients with acute anterior circulation ischemic stroke and the prognosis of endovascular treatment. Methods A retrospective analysis of 52 patients with acute anterior circulation ischemic stroke treated with endovascular treatment in the First People’s Hospital of Anqing City from February 2015 to December 2018. CIS performed with whole brain DSA before endovascular treatment showed 27 patients with good fCIS, 25 patients with poorCIS (pCIS). According to Modified Rankin Scale (mRS)), there were 24 and 28 cases in the good (< 2 points) and poor (> 3 points) prognosis group. Univariate analysis was used to compare the baseline data and clinical data of two groups. Multivariate logistic regression analysis was performed to analyze the effect of CIS on prognosis. Results There was no significant difference between fCIS group and pCIS group in age, gender, history of diabetes, systolic blood pressure, atrial fibrillation, hyperlipidemia, NIHSS score, onset time to TIR (all P > 0.05 ); the differences in DWI-ASPECTS score and mTICI ≥ IIb were statistically significant (all P < 0.05); there were no significant differences in age, gender, history of diabetes mellitus, systolic blood pressure, atrial fibrillation, hyperlipidemia, NIHSS score, onset to revascularization time (TIR) between the good prognosis group and the poor prognosis group(all P > 0.05 ); the differences in in DWI-ASPECTS score, mTICI ≥ IIb and fCIS were statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that the scores of mTICI [Ol^R = 5.603, (95%CI: 2.035, 21.447)], DWI-ASPECTS [Ol^R = 0.625, (95%CI : 0.472, 0.826)] and CIS [Ol^R = 8.474, (95%CI: 2.478, 32.516)] were predictors of endovascular treatment outcome. Conclusion CIS can be used to evaluate brain perfusion and capillary filling, DWI-ASPECT score and CIS may be used to predict the prognosis of patients with acute ischemic stroke, while EVT is increasing.