标题：支架取栓治疗大脑中动脉闭塞患者的效果及预后影响因素分析

      作者：柴源，苗宇，罗强    西安市中心医院神经外科，陕西 西安 710004

      卷次： 2022年33卷19期

      【摘要】 目的 分析支架取栓对大脑中动脉闭塞(MCAO)患者的治疗效果及预后影响因素。方法 回顾性分析2016年1月至2021年1月西安市中心医院神经外科收治的98例MCAO患者的临床资料，根据治疗方式的不同分为动脉溶栓组(n=48)和支架取栓组(n=50)。比较两组患者的临床疗效、治疗前后的神经细胞损害标志物水平[神经元特异性烯醇化酶(NSE)、S100B蛋白、重组VILIP1蛋白、脑源性神经营养因子(BDNF)]及不良反应。溶栓后3个月，根据改良Rankin量表(mRS)将支架取栓组患者分为预后良好组(n=29)和预后不良组(n=21)，采用Logistic回归分析支架取栓治疗MCAO患者预后的影响因素。结果 支架取栓组患者的治疗总有效率为96.00%，明显高于动脉溶栓组的83.33%，差异有统计学意义(P<0.05)；治疗后，支架取栓组患者的NSE、S100B、VILIP1水平分别为(16.71±3.18) ng/mL、(1.09±0.26) ng/mL、(286.64±37.54) pg/mL，明显低于动脉溶栓组的(21.64±3.50) ng/mL、(1.60±0.30) ng/mL、(362.51±42.46) pg/mL，而BDNF水平为(4.16±0.44) ng/mL，明显高于动脉溶栓组的(3.05±0.38) ng/mL，差异均有统计学意义(P<0.05)；支架取栓组患者的二次栓塞、颅内出血、症状性颅内出血发生率分别为10.00%、10.00%、2.00%，与动脉溶栓组的4.17%、12.50%、10.42%比较差异均无统计学意义(P>0.05)；经多因素Logistic回归分析结果显示，年龄(OR=1.169，95%CI：1.015~1.346)、发病至治疗时间(OR=1.439，95%CI：1.052~1.969)、高血压(OR=3.456，95%CI：1.284~9.298)、取栓24 h后美国国立卫生研究院卒中量表(NIHSS)评分(OR=2.333，95%CI：1.082~5.029)是影响支架取栓治疗MCAO患者预后的独立危险因素(P<0.05)。结论 支架取栓治疗MCAO可减轻患者的神经功能损伤，具有较好的临床疗效，且安全性较好；年龄、发病至治疗时间、高血压及取栓24 h后NIHSS评分是影响支架取栓治疗MCAO患者预后的独立危险因素，临床医生应给予重视。
      【关键词】 动脉闭塞；支架取栓；临床疗效；预后；影响因素
      【中图分类号】 R743 【文献标识码】 A 【文章编号】 1003—6350（2022）19—2496—04

Effect and prognostic influencing factors of stent thrombectomy in the treatment of patients with middle cerebralartery occlusion.
CHAI Yuan, MIAO Yu, LUO Qiang. Department of Neurosurgery, Xi'an Central Hospital, Xi'an 710004,Shaanxi, CHINA
【Abstract】 Objective To analyze the therapeutic effect and prognostic factors of stent thrombectomy in thetreatment of patients with middle cerebral artery occlusion (MCAO). Methods The clinical data of 98 patients withMCAO admitted to the Department of Neurosurgery, Xi'an Central Hospital from January 2016 to January 2021 was ret-rospectively analyzed. According to different treatment methods, the patients were divided into an arterial thrombolysisgroup (n=48) and a stent thrombectomy group (n=50). The clinical efficacy, nerve cell damage markers before and aftertreatment [neuron specific enolase (NSE), S100B protein, recombinant VILIP1 protein, brain-derived neurotrophic factor(BDNF)], and adverse reactions were compared between the two groups. Three months after thrombolysis, according tothe modified Rankin scale (mRS), the patients in the stent thrombectomy group were divided into a good prognosis group(n=29) and a poor prognosis group (n=21). Logistic regression was used to analyze the prognostic factors of stent throm-bectomy for MCAO patients. Results The total effective rate of patients in the stent thrombectomy group was 96.00%,significantly higher than 83.33% of arterial thrombolysis group (P<0.05). After treatment, the levels of NSE, S100B,and VILIP1 in stent thrombectomy group were (16.71±3.18) ng/mL, (1.09±0.26) ng/mL, and (286.64±37.54) pg/mL, re-spectively, which were significantly lower than (21.64±3.50) ng/mL, (1.60±0.30) ng/mL, (362.51±42.46) pg/mL in arte-rial thrombolytic group (P<0.05), and the BDNF level was (4.16±0.44) ng/mL, which was significantly higher than(3.05±0.38) ng/mL in arterial thrombolytic group, with significantly significant differences (P<0.05). The incidence ofsecondary embolism, intracranial hemorrhage, and symptomatic intracranial hemorrhage in stent thrombolysis group was10.00%, 10.00%, and 2.00%, respectively, which showed no statistically significant difference as compared with 4.17%,12.50%, and 10.42% in arterial thrombolysis group (P>0.05). Multivariate logistic regression analysis showed that age(OR=1.169, 95%CI: 1.015-1.346), onset to treatment time (OR=1.439, 95%CI: 1.052-1.969), hypertension (OR=3.456,95%CI: 1.284-9.298), US National Institutes of Health Stroke Scale (NIHSS) score after thrombectomy for 24 h (OR=