上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (09): 1270-1276.doi: 10.3969/j.issn.1674-8115.2020.09.017

• 论著·临床研究 • 上一篇    下一篇

不明原因脑栓塞与心源性脑卒中机械取栓预后的比较

刘译升1，詹艳丽2，潘 辉1，尹家文1，胡 玥1，蔡学礼2#，刘建仁1#   

  1. 1. 上海交通大学医学院附属第九人民医院神经内科，上海 200011；2. 浙江大学附属丽水市中心医院神经内科，丽水 323000
  • 出版日期:2020-09-28 发布日期:2020-11-04
  • 通讯作者: 刘建仁，电子信箱：liujr021@sjtu.edu.cn。蔡学礼，电子信箱：caixueli111@163.com。#为共同通信作者。
  • 作者简介:刘译升（1992—），男，住院医师，硕士；电子信箱：350491451@qq.com。
  • 基金资助:
    上海市教育委员会高峰高原学科项目（20161422）。

Comparison of outcomes after thrombectomy in patients with embolic stroke of undetermined source and cardiogenic stroke

LIU Yi-sheng1, ZHAN Yan-li2, PAN Hui1, YIN Jia-wen1, HU Yue1, CAI Xue-li2#, LIU Jian-ren1#   

  1. 1. Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 2. Department of Neurology, Lishui Central Hospital, Zhejiang University, Lishui 323000, China
  • Online:2020-09-28 Published:2020-11-04
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support (20161422).

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摘要： 目的·比较不明原因脑栓塞（embolic stroke of undetermined source，ESUS）和心源性脑卒中（cardiogenic stroke，CS）所致颅内动脉闭塞患者机械取栓的临床特征和治疗效果。方法·回顾性收集上海交通大学医学院附属第九人民医院以及浙江大学附属丽水市中心医院2012年11月—2019年4月接受机械取栓治疗的患者资料，用t检验、Mann-Whitney U检验对定量资料进行比较，用χ2检验、Fisher精确概率法对定性资料进行比较，用Logistic回归分析影响预后的独立危险因素。结果·共纳入117例患者，ESUS组30例，CS组87例。ESUS组平均年龄较小（64岁 vs 75岁，P=0.003）、平均基线美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）评分较低（12分 vs 15分，P=0.020），平均术后24 h NIHSS评分较低（10分 vs 12分，P=0.033），平均90 d改良Rankin量表评分较低（2分 vs 4分，P=0.015），但两者血管再通率比较差异无统计学意义。Logistic回归分析显示高血压（OR=0.264，95%CI 0.099～0.704，P=0.008）、基线NIHSS评分（OR=0.758，95%CI 0.673～0.853，P=0.000）是影响预后的独立危险因素。结论·与CS患者相比，ESUS患者发病年龄较轻、起病时神经功能缺损症状较轻、预后较好，但均有较高的死亡率。两者机械取栓再通率相似。基线NIHSS评分、高血压是影响预后的独立危险因素。

关键词: 急性缺血性脑卒中, 机械取栓, 不明原因脑栓塞, 心源性脑卒中, 基线NIHSS评分, 高血压

Abstract:

Objective · To compare the baseline characteristics and treatment outcomes of mechanical thrombectomy in patients with intracranial arterial occlusion caused by embolic stroke of undetermined source and cardiogenic stroke. Methods · Retrospective analysis was made on ESUS and CS patients in registration databases who received thrombectomy in two stroke centers, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine and Lishui Central Hospital, Zhejiang University from November 2012 to April 2019. T-test and Mann-Whitney U test were used to compare the measurement data, χ2 test and Fisher's exact test were used to compare the counting data, and the independent prognostic risk factors were analyzed by Logistic regression. Results · In all, 117 participants were eventually enrolled, including 30 (25.6%) with ESUS and 87 (74.4%) with CS. Compared with the CS group, the ESUS group was significantly younger (mean ages, 64 years vs 75 years, P=0.003) with lower median baseline NIHSS scores (12 vs. 15, P=0.020), lower median NIHSS scores at 24 h (10 vs 12, P=0.033) and lower median MRS scores at 90 days (2 vs 4, P=0.015). The rates of successful recanalization were similar. Logistic regression analysis showed hypertension (OR=0.264, 95%CI 0.099-0.704, P=0.008) and baseline NIHSS scores (OR=0.758, 95%CI 0.673-0.853, P=0.000) were independent risk factors affecting prognoses. Conclusion · Compared with CS, ESUS patients are relatively younger and have milder neurological dysfunction at onset and better prognoses; however, both groups have high mortality rates. The successful recanalization rates for mechanical thrombectomy are similar. The baseline NIHSS score and hypertension are independent prognostic risk factors.

Key words: acute ischemic stroke, mechanical thrombectomy, embolic stroke of undetermined source, cardiogenic stroke, baseline NIHSS score, hypertension

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