[1]乔静.急性缺血性脑卒中介入术后早期疾病进展危险因素及基于颅内CT影像学特征的预测模型构建[J].卒中与神经疾病杂志,2025,32(01):65-69.[doi:10.3969/j.issn.1007-0478.2025.01.011]
点击复制

急性缺血性脑卒中介入术后早期疾病进展危险因素及基于颅内CT影像学特征的预测模型构建()
分享到：

《卒中与神经疾病》杂志[ISSN:1007-0478/CN:42-1402/R]

卷:
第32卷
期数:
2025年01期
页码:
65-69
栏目:
脑梗死
出版日期:
2025-02-20

文章信息/Info

文章编号:
1007-0478(2025)01-0065-05
作者:
乔静
010017 呼和浩特,内蒙古自治区人民医院神经内科
关键词:
急性缺血性脑卒中 介入手术 疾病进展 CT
分类号:
R743.32 R743.33
DOI:
10.3969/j.issn.1007-0478.2025.01.011
文献标志码:
A
摘要:
目的 探讨急性缺血性脑卒中介入术后早期疾病进展危险因素并进一步构建基于颅内CT影像学特征的预测模型,旨在为早期识别疾病进展高危人群及制定个性化治疗方案提供更多借鉴。方法 回顾性纳入2020年6月-2024年6月于本院行介入手术治疗急性缺血性脑卒中患者共188例,根据术后72 h内是否发生疾病进展分组; 急性缺血性脑卒中介入术后早期疾病进展危险因素单因素分析以及多因素分析; 急性缺血性脑卒中介入术后早期疾病进展与临床特征的相关性分析; 急性缺血性脑卒中介入术后早期疾病进展风险预测模型构建及预测效能分析。结果 本研究纳入188例患者术后72 h内发生疾病进展73例,发生率为 38.83%; 单因素分析显示,基线美国国立卫生研究院卒中量表(National institute of health stroke scale,NIHSS)评分、有无出现电子计算机断层扫描(Computed tomography,CT)高密病灶、CT高密度病灶体积、CT最大值及CT平均值均可能与急性缺血性脑卒中介入术后早期疾病进展有关(P<0.05); logistic多因素分析显示,基线NIHSS评分、合并CT高密病灶、CT高密度病灶体积、CT最大值及CT平均值均是急性缺血性脑卒中介入术后早期疾病进展的独立危险因素(P<0.05); 基线NIHSS评分、CT高密度病灶体积、CT最大值及CT平均值与急性缺血性脑卒中介入术后早期疾病进展发生具有相关性(P<0.05); 利用基线NIHSS评分、合并CT高密病灶、CT高密度病灶体积、CT最大值、CT平均值以及P值预测概率对急性缺血性脑卒中介入术后早期疾病进展风险的情况进行受试者工作特征(Receiver operating characteristic,ROC)曲线的预测,曲线下面积分别为 0.715、0.643、0.732、0.830、0.716、0.918。结论 急性缺血性脑卒中介入术后早期疾病进展与基线NIHSS评分、有无出现CT高密病灶、CT高密度病灶体积、CT最大值及CT平均值关系密切; 利用以上5个因素构建的数据模型对于患者的术后早期疾病进展预测显示出良好的效能。

参考文献/References:

[1] Zhang YK,He Y,Chen S,et al.Safety and efficacy of intravascular therapy in patients with progressive stroke caused by intracranial large vascular occlusion exceeding the time window of 24 hours[J].Neurol Res,2021,43(12):1031-1039.
[2] 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,中华医学会神经病学分会神经血管介入协作组.中国急性缺血性卒中早期血管内介入诊疗指南2022[J].中华神经科杂志,2022,55(6):565-580.
[3] Ryu WS,Hong KS,Jeong SW,et al.Association of ischemic stroke onset time with presenting severity, acute progression, and long-term outcome: a cohort study[J].PLoS Med,2022,19(2):e1003910.
[4] 邢鹏飞,沈芳,李子付,等.急性缺血性脑卒中血管内治疗常见不良事件和预后分析[J].第二军医大学学报,2021,42(2):146-152.
[5] Chen ZY,Zhang YB,Su YY,et al.Contrast extravasation is predictive of poor clinical outcomes in patients undergoing endovascular therapy for acute ischemic stroke in the anterior circulation[J].J Stroke Cerebrovasc Dis,2020,29(1):104494.
[6] 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(9):666-682.
[7] 何晓清,梁汉欢,戴顺钦,等.血管内介入治疗缺血性脑卒中后脑内高密度影与出血转化的关系[J].中国介入影像与治疗学,2022,19(7):406-410.
[8] Widimsky P,Snyder K,Sulzenko J,et al.Acute ischaemic stroke: recent advances in reperfusion treatment[J].Eur Heart J,2023,44(14):1205-1215.
[9] 何晓清,梁汉欢,戴顺钦,等.双能CT融合图像的延迟点征对缺血性卒中介入术后颅内出血的预测价值[J].中国医学影像学杂志,2022,30(10):986-990, 995.
[10] Pankheaw T,Hiengkaew V,Bovonsunthonchai S,et al.Effect of progressive bridging exercise on weight-bearing during the extension phase of sit-to-stand, and on sit-to-stand ability in individuals with stroke: a randomised controlled trial[J].Clin Rehabil,2022,36(11):1463-1475.
[11] Polson JS,Zhang HY,Nael K,et al.Identifying acute ischemic stroke patients within the thrombolytic treatment window using deep learning[J].J Neuroimaging,2022,32(6):1153-1160.
[12] Jiang QM,Hou J,Ge J,et al.Clinical significance of hyperdense area after endovascular therapy in patients with acute ischemic stroke: a systematic review and meta-analysis[J].Cerebrovasc Dis,2021,50(5):500-509.
[13] Hong L,Hsu TM,Zhang YR,et al.Neuroimaging prediction of hemorrhagic transformation for acute ischemic stroke[J].Cerebrovasc Dis,2022,51(4):542-552.
[14] Wu LF,Wei M,Zhang BH,et al.Safety and tolerability of direct ischemic postconditioning following thrombectomy for acute ischemic stroke[J].Stroke,2023,54(9):2442-2445.
[15] Pinter D,Gattringer T,Fandler-Höfler S,et al.Early progressive changes in white matter integrity are associated with stroke recovery[J].Transl Stroke Res,2020,11(6):1264-1272.
[16] 俞帅,姜倩梅,郭志良,等.急性缺血性卒中取栓术后无效再通动态列线图模型的建立与验证[J].中华神经科杂志,2022,55(10):1118-1127.
[17] An H,Zhao WB,Wang JG,et al.Contrast staining may be associated with intracerebral hemorrhage but not functional outcome in acute ischemic stroke patients treated with endovascular thrombectomy[J].Aging Dis,2019,10(4):784-792.
[18] de Oliveira EP,Fiebach JB,Vagal A,et al.Controversies in imaging of patients with acute ischemic stroke: AJR expert panel narrative review[J]. Am J Roentgenol,2021,217(5):1027-1037.
[19] Lai MC,Zhang XJ,Zhou DY,et al.Integrating serum proteomics and metabolomics to compare the common and distinct features between acute aggressive ischemic stroke(APIS)and acute non-aggressive ischemic stroke(ANPIS)[J].J Proteomics,2022,261:104581.
[20] Cheng Z,Geng XK,Rajah GB,et al.NIHSS consciousness score combined with ASPECTS is a favorable predictor of functional outcome post endovascular recanalization in stroke patients[J].Aging Dis,2021,12(2):415-424.

更新日期/Last Update: 2025-02-20