杨莎莎;林惠卿;方欣欣;周戈;

• 1:中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)

摘要(Abstract)：

目的 探讨急性缺血性脑卒中（AIS）患者临床预后的影响因素及与CT灌注成像（CTP）评估侧支循环状态的关系。方法 回顾性纳入2017-01—2021-06于中国人民解放军联勤保障部队第九〇九医院行取栓手术治疗的AIS患者221例，均经多模态CTP评估侧支循环状态，分析临床特征资料及预后情况，采用多元线性回归模型分析梗死体积扩大的危险因素，采用二元Logistic回归模型分析侧支循环不良及预后不良的危险因素。结果 侧支循环不良组年龄、基线空腹血糖（FPG）水平及合并房颤、冠心病、心功能不全、觉醒性卒中、颈内动脉段闭塞比例均显著高于侧支循环不良组（P<0.05）；侧支循环良好组术前静脉溶栓比例显著低于侧支循环不良组（P<0.05）；多因素分析显示，年龄增加、合并心功能不全、基线FPG水平升高、合并觉醒性卒中及颈内动脉段闭塞是侧支循环不良的独立危险因素（P<0.05）。多元线性回归模型纳入经双变量检验筛选梗死体积扩大的相关因素，步进法分析显示，侧支循环不良、缺血半暗带体积减少、合并出血转化（HT）及术后1 d美国国立卫生研究院卒中量表（NIHSS）评分下降是梗死体积扩大的独立危险因素（P<0.05），其中模型R²=0.91。预后不良组年龄、住院时间、基线FPG水平、合并房颤比例、合并冠心病比例、合并心功能不全比例、合并觉醒性脑卒中比例、合并颈内动脉段闭塞比例、侧支循环不良比例、核心梗死体积、最终梗死体积、梗死扩大体积、合并HT比例、基线及术后各时间点NIHSS评分均显著高于预后良好组（P<0.05），多因素分析显示合并HT和梗死扩大体积是患者预后不良的独立危险因素（P<0.05），其中模型R2=0.85。结论 AIS患者病情进展及预后不良与多种因素有关，其中基于多模式CTP评估侧支循环状态可独立预测病情进展及预后不良风险。

关键词(KeyWords)： 急性缺血性脑卒中;CT灌注成像;预后;梗死面积;侧支循环;危险因素

Abstract:

Keywords:

基金项目(Foundation): 2017年度青年苗圃基金资助项目（编号：17Y026）

作者(Authors): 杨莎莎;林惠卿;方欣欣;周戈;

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