D-二聚体对急性前循环大血管闭塞缺血性脑卒中患者行血管内治疗后预后不良的预测价值

目的 探索前循环急性大血管闭塞缺血性脑卒中(AIS-LVO)行血管内治疗(EVT)后预后不良的危险因素,明确D-二聚体对AIS-LVO行EVT后预后不良的预测价值。方法 选取2018年12月-2022年12月在河北省人民医院神经内科住院的AIS-LVO行EVT的患者作为研究对象,根据术后90天改良RANKIN量表(mRS)评分分为预后良好组和预后不良组,收集研究对象的ASPECT评分、NIHSS评分、mTICI分级、一般资料、实验室资料等,采用二元Logistic回归分析AIS-LVO患者行EVT后预后不良的影响因素,绘制受试者工作曲线。结果 共纳入143名AIS-LVO行EVT的患者,预后良好组与预后不良组相比,年龄、术前NIHSS评分、ASPECT评分、Glasgow评分、术后即刻mTICI分级、术前D二聚体水平差异有统计学意义(P＜0.05);二元logistic回归分析显示术前NIHSS评分[OR=1.096,95%CI(1.007,1.193)]、术后即刻mTICI分级[OR=19.609,95%CI(5.354,71.815)]、术前D二聚体水平[OR=1.310,95%CI(1.128,1.521)]是AIS-LVO行EVT患者预后不良的独立危险因素;D-二聚体对AIS-LVO患者EVT预后不良的受试者工作曲线,曲线下面积为0.642(95%置信区间0.54, 0.745)。结论 术前NIHSS评分、术后即刻mTICI分级、术前D-二聚体水平升高是AIS-LVO行EVT患者预后不良的独立危险因素。术前D-二聚体水平升高的AIS-LVO患者行EVT后预后可能较差。

Predictive value of D-dimer for poor prognosis of acute ischemic stroke with large vessel occlusion patients after endovascular treatment

Objective To explore the risk factors for poor prognosis after endovascular therapy (EVT) in acute ischemic stroke with large vessel occlusion (AIS-LVO), in order to determine the predictive value of D-dimer for poor prognosis of AIS-LVO after EVT. Methods AIS-LVO patients who received EVT and were hospitalized in the Department of Neurology of Hebei General Hospital from December 2018 to December 2022 were selected as study objects. According to the modified RANKIN Scale (mRS) score 90 days after EVT, they were divided into good prognosis group and poor prognosis group. ASPECT score, NIHSS score, mTICI grade, general data and laboratory data of AIS-LVO patients were collected. Binary Logistic regression was used to analyze the influencing factors of poor prognosis in AIS-LVO patients after EVT, and draw receiver operating characteristic curve. Results There were 143 AIS-LVO patients receiving EVT. Between the good prognosis group and the poor prognosis group, age, preoperative NIHSS score, ASPECT score, Glasgow score, immediate postoperative mTICI grading and preoperative D-dimer level were statistically significant differences(P < 0.05). Binary logistic regression analysis showed that preoperative NIHSS score[OR=1.096,95%CI(1.007,1.193)], immediate postoperative mTICI grading[OR=19.609,95%CI(5.354,71.815)] and preoperative D-dimer level[OR=1.310,95%CI(1.128,1.521)] was an independent risk factor for poor prognosis in AIS-LVO patients who treated with EVT. Receiver operating characteristic curve of D-dimer effect on poor prognosis after EVT in AIS-LVO patients was draw, and area under curve was 0.642(95% confidence interval 0.54, 0.745). Conclusion Preoperative NIHSS score, immediate postoperative mTICI grading and higher D-dimer level were independent risk factor for poor prognosis in AIS-LVO patients who treated with EVT. Patients with AIS-LVO with elevated D-dimer levels before surgery may have a poor prognosis after EVT.