DRAGON评分对颅内大血管闭塞致急性缺血性卒中静脉溶栓桥接机械取栓临床结局的预测作用

目的评估前循环颅内大血管闭塞致急性缺血性卒中患者入院时DRAGONdense cerebral artery,mRS(改良Rankin量表),age,glucose level,onset to treatment time,NIHSS(美国国立卫生研究院卒中量表)]评分对静脉溶栓桥接机械取栓术后患者临床结局的预测作用。方法回顾性连续纳入2015年1—12月急性缺血性卒中血管内治疗试验(EAST)中接受机械取栓及静脉溶栓桥接机械取栓治疗的急性缺血性卒中患者149例,为发病至治疗时间≤6 h,于术前经CT血管成像和(或)MR血管成像和(或)DSA证实。根据治疗后90 d mRS评分,将149例患者分为预后良好(mRS评分0~2分)组和预后不良(mRS评分3~6分)组。收集并比较两组患者的人口学资料、脑血管病危险因素(高血压病、糖尿病、心房颤动等)、入院时NIHSS评分、发病时间、卒中前mRS评分、影像学特征、实验室检查、DRAGON评分、治疗方式的差异。对静脉溶栓桥接机械取栓不同预后者上述指标进行比较,并采用受试者工作特征(ROC)曲线确定DRAGON预测静脉溶栓桥接机械取栓患者预后的最佳截断值。结果(1)预后良好组患者基线NIHSS评分低于预后不良组14(11,18)分比18(14,21)分],男性比例高于预后不良组71.1%(59/83)比50.0%(33/66)],组间差异均有统计学意义(均P<0.01);两组年龄、高血压病、糖尿病、心房颤动、高脂血症、卒中史、高密度征、早期脑梗死征象的差异均无统计学意义(均P>0.05)。(2)预后良好组血糖水平及基线DARGON评分均低于预后不良组,组间差异均有统计学意义(6.5±1.5)mmol/L比(8.2±3.3)mmol/L,(4.4±1.3)分比(5.2±1.4)分;均P<0.01];两组发病至治疗时间、发病至再通时间、血肌酐、白细胞计数、卒中前mRS 0~1分比例及静脉溶栓桥接机械取栓比例的差异均无统计学意义(均P>0.05)。(3)静脉溶栓桥接机械取栓术后预后良好者基线NIHSS评分、发病至治疗时间、发病至成功再通时间、血糖水平、基线DARGON评分均低于预后不良者,二者差异均有统计学意义14(10,16)分比19(16,24)分,168(126,134)min比239(210,295)min,199(183,285)min比275(260,345)min,(6.4±1.2)mmol/L比(9.0±2.4)mmol/L,(4.3±1.5)分比(6.1±1.2)分;均P<0.05];二者间其余基线和临床资料的差异均无统计学意义(均P>0.05)。(4)基线DRAGON评分预测静脉溶栓桥接机械取栓术后90 d预后的ROC曲线下面积为0.830,最佳截断值为6分,其敏感度为63.6%,特异度为91.7%。结论入院时DRAGON评分可能对前循环大血管闭塞致急性缺血性卒中患者接受静脉溶栓桥接机械取栓后的预后具有一定的预测作用。

DRAGON score predicts clinical outcomes in acute ischemic stroke patients receiving intravenous thrombolysis with mechanical thrombectomy due to intracranial large artery occlusion

Objective The aim of the study was to evaluate the influence of DRAGON score(dense artery sign,the modified Rankin scalemRS],age,blood glucose level,onset to treatment time,the National Institute of Health stroke scaleNIHSS])on clinical outcomes of intravenous thrombolysis with mechanical thrombectomy.Methods From January to December 2015,149 consecutive patients with acute ischemic stroke receiving intravenous thrombolysis with mechanical thrombectomy due to occlusion of the anterior circulation and with endovascular treatment within 6 h of symptom onset registered in the endovascular therapy for acute ischemic stroke trial(EAST)were retrospectively recruited.The anterior circulation occlusion in all enrolled patients were confirmed by preoperative computer tomography angiography/magnetic resonance angiography/digital subtraction angiography.According to mRS score at 90 d after treatment,149 patients were divided into the good prognosis group(mRS score 0-2)and the poor prognosis group(mRS score 3-6).Demographic data,cerebrovascular disease risk factors(hypertension,diabetes,atrial fibrillation,etc.),NIHSS score at admission,onset time,pre-stroke mRS score,imaging characteristics,laboratory examination,DRAGON score,and treatment methods were collected and compared between the two groups.The above indexes were compared among different preconditions for intravenous thrombolysis with mechanical thrombectomy,and the receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of DRAGON score for the prognosis of patients with intravenous thrombolysis with mechanical thrombectomy.Results(1)The baseline NIHSS score of patients in the good prognosis group was lower than that in the poor prognosis group(1411,18]vs.1814,21]),and the male ratio was higher than that in the poor prognosis group(71.1%59/83]vs.50.0%33/66]).The difference between groups was statistically significant(all P<0.05).There were no statistically significant differences in age,hypertension,diabetes,atrial fibrillation,hyperlipidemia,stroke history,high density sign and early cerebral infarction sign between the two groups(all P>0.05).(2)The blood glucose level and baseline DARGON score of the good prognosis group were lower than the poor prognosis group with statistically significant differences(6.5±1.5]mmol/L vs.8.2±3.3]mmol/L,4.4±1.3]score vs.5.2±1.4]score;all P<0.01).There were no statistically significant differences in the time from onset to treatment,time from onset to recanalization,creatinine,white blood cell count,proportion of mRS 0-1 points before stroke,and proportion of intravenous thrombolysis with mechanical thrombectomy between the two groups(all P>0.05).(3)The good prognosis group had lower baseline NIHSS score,onset to treatment time,onset to successful recanalization time,blood glucose level and baseline DARGON scores than the poor prognosis group with statistically significant differences(1410,16]score vs.1916,24]score,168126,134]min vs.239210,295]min,199183,285]min vs.275260,345]min,6.4±1.2]mmol/L vs.9.0±2.4]mmol/L and4.3±1.5]score vs.6.1±1.2]score;all P<0.05).There were no statistically significant differences in the remaining baseline and clinical data between the two groups(all P>0.05).(4)The area under the ROC curve predicted by the baseline DRAGON score was 0.830 at 90 days after intravenous thrombolysis with mechanical thrombectomy;the optimal cut-off value was 6 points;the sensitivity was 63.6%,and the specificity was 91.7%.Conclusion This study suggested that DRAGON score may be an independent predictor of good clinical outcomes after intravenous thrombolysis with mechanical thrombectomy in acute ischemic stroke patients with anterior circulation occlusion.