急性前循环大血管闭塞性脑卒中直接取栓与桥接治疗比较及预后研究

朱东梅; 葛冬涛; 韩若东; 杨淼

doi:10.16766/j.cnki.issn.1674-4152.003951

急性前循环大血管闭塞性脑卒中直接取栓与桥接治疗比较及预后研究

doi: 10.16766/j.cnki.issn.1674-4152.003951

朱东梅^{1, 2},
葛冬涛^{1, 2},
韩若东³,
杨淼^4, ,

1.
蚌埠医科大学研究生院，安徽蚌埠 233000
2.
安徽医科大学附属亳州医院全科医学科，安徽亳州 236000
3.
安徽医科大学附属亳州医院重症医学科
4.
安徽医科大学附属亳州医院神经内科

基金项目:

蚌埠医科大学2023年度研究生科研创新计划项目 Byycx23150

安徽高校自然科学研究项目 2022A H050688

详细信息

通讯作者:
杨淼，E-mail：13965796578@163.com

中图分类号: R743.3 R730.7
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出版历程
- 收稿日期: 2024-06-24
- 网络出版日期: 2025-06-30

Comparison and prognosis of direct thrombectomy and bridging therapy for acute anterior circulation large vessel occlusive stroke

ZHU Dongmei^{1, 2},
GE Dongtao^{1, 2},
HAN Ruodong³,
YANG Miao^{4
, ,}

1.
Graduate School of Bengbu Medical University, Bengbu, Anhui 233000, China

摘要

摘要: 目的比较急性前循环大血管闭塞缺血性脑卒中(AIS-LVO)患者接受直接机械取栓(dMT)与桥接治疗(BT)的效果，并探析其预后的影响因素。方法选取2020年1月—2023年7月于安徽医科大学附属亳州医院接受dMT或BT治疗的AIS-LVO患者265例，根据治疗方式分为桥接治疗组(BT组)和直接机械取栓组(dMT组)。收集临床数据，比较2种治疗方式的效果，并使用单因素及多因素logistic回归探析影响AIS-LVO预后的因素。结果 2组发病时间、发病前改良Rankin量表评分、入院至动脉穿刺时间、入院美国国立卫生研究院卒中量表(NIHSS)评分、合并高血压比例、中重度残疾率、死亡率差异均有统计学意义(P < 0.05)。倾向性评分匹配后，BT组中重度残疾比例高于dMT组(P < 0.05)，但2组获得良好功能结局患者比例、死亡率及sICH发生率差异均无统计学意义(P＞0.05)。多因素logistic回归分析结果显示，年龄60~80岁(OR=3.421, 95% CI：1.809~6.471，P＜0.001)、高入院NIHSS评分(OR=1.069，95% CI：1.017~1.124，P=0.009)及有糖尿病史(OR=3.252, 95% CI：1.531~6.908，P=0.002)均为AIS-LVO患者预后不良的独立危险因素。结论对于AIS-LVO患者，桥接治疗与直接机械取栓的临床疗效及安全性相当。高入院NIHSS评分、高龄及合并糖尿病是AIS-LVO患者不良预后的独立危险因素。
- 急性缺血性脑卒中 /
- 前循环大血管闭塞 /
- 桥接治疗 /
- 直接机械取栓 /
- 预后
Abstract: Objective To compare the efficacy of direct mechanical thrombectomy (dMT) with bridging therapy (BT) in patients with acute ischaemic stroke with anterior circulation large vessel occlusion (AIS-LVO) and to identify factors influencing their prognosis. Methods The present study examined the efficacy of dMT and BT in AIS-LVO patients treated at Bozhou Hospital Affiliated to Anhui Medical University, from January 2020 to July 2023. Patients were stratified into two distinct groups, namely the BT group and the dMT group, based on the respective treatment modalities received. A comprehensive set of clinical data was collected, and a comparative analysis of the efficacy of these two treatment modalities was conducted. The factors influencing the prognosis of AIS-LVO were analyzed by univariate and multivariate logistic regression. Results A number of significant differences were identified between the two groups in terms of the time of onset, pre-onset modified Rankin scale score, door-to-puncture time, admission National Institute of Health stroke scale (NIHSS) score, proportion of patients with hypertension, moderate-to-severe disability rate and mortality (P < 0.05). Following the implementation of propensity score matching, no statistically significant differences were observed between the two groups with respect to the 90-day good functional outcome rate, symptomatic intracranial hemorrhage rate, or mortality rate (P>0.05). However, the BT group demonstrated a higher rate of moderate to severe disability in comparison to the dMT group. Multivariate logistic regression analysis revealed that age was 60-80 years old (OR=3.421, 95% CI: 1.809-6.471, P < 0.001), high NIHSS scores upon admission (OR=1.069, 95% CI: 1.017-1.124, P=0.009), and history of diabetes (OR=3.252, 95% CI: 1.531-6.908, P=0.002) were independent risk factors for poor prognosis in AIS-LVO patients. Conclusion The present study has demonstrated that bridging therapy and direct mechanical thrombectomy demonstrate comparable clinical efficacy and safety in AIS-LVO patients. Furthermore, it has been demonstrated that elevated NIHSS scores upon admission, advanced age and the presence of concomitant diabetes are independent risk factors for poor unfavourable in AIS-LVO.
- Acute ischemic stroke /
- Anterior circulation large vessel occlusion /
- Bridging therapy /
- Direct mechanical thrombectomy /
- Prognosis

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表 1 PSM前后2组AIS-LVO患者基线特征及临床结局比较

Table 1. Comparison of baseline characteristics and clinical outcomes between two groups of AIS-LVO patients before and after PS

项目	PSM前				PSM后
项目	桥接治疗组(n=94)	直接取栓组(n=171)	统计量	P值	桥接治疗组(n=67)	直接取栓组(n=67)	统计量	P值
年龄[M(P₂₅, P₇₅), 岁]	70.0(64.0, 74.3)	69.0(57.0, 74.0)	-1.252^a	0.210	69.5(63.0, 75.3)	69.5(59.0, 74.3)	-0.430^a	0.667
性别[例(%)]			0.663^b	0.415			0.275^b	0.600
男性	56(59.6)	93(54.4)			40(59.7)	37(55.2)
女性	38(40.4)	78(45.6)			27(40.3)	30(44.8)
危险因素[例(%)]
高血压	73(77.7)	110(64.3)	5.045^b	0.025	49(73.1)	45(67.2)	0.570^b	0.450
糖尿病	19(20.2)	35(20.5)	0.002^b	0.961	13(19.4)	20(29.9)	1.970^b	0.160
冠心病	21(22.3)	55(32.2)	2.862^b	0.091	33(49.3)	35(52.2)	0.119^b	0.730
房颤	39(41.5)	90(52.6)	3.014^b	0.083	16(23.9)	24(35.8)	2.281^b	0.131
TOAST分型[例(%)]			2.751^b	0.097			1.094^b	0.296
心源性	33(35.1)	78(45.6)			26(38.8)	32(47.8)
大动脉粥样硬化性	61(64.9)	93(54.4)			41(61.2)	35(52.2)
发病前mRS评分[例(%)]			-1.664^a	0.096			-1.485^a	0.138
0分	90(95.7)	154(90.1)			65(97.0)	61(91.0)
1分	4(4.3)	13(7.6)			2(3.0)	3(4.5)
2分	0	4(2.3)			0	3(4.5)
发病时间[例(%)]			13.554^b	< 0.001			0.319^b	0.572
≤4.5 h	85(90.4)	121(70.8)			59(88.1)	61(91.0)
4.5~6.0 h	9(9.6)	50(29.2)			8(11.9)	6(9.0)
入院NIHSS评分[M(P₂₅, P₇₅), 分]	17.0(12.0, 20.0)	18.0(15.0, 22.0)	-2.788^a	0.005	17.6±5.2	16.7±5.5	1.013^c	0.313
DPT[M(P₂₅, P₇₅), min]	108.0(84.0, 152.0)	81.0(39.3, 112.0)	-5.439^a	< 0.001	98.0(81.0, 139.3)	105.0(74.8, 140.3)	-0.158^a	0.874
术后24 h NIHSS评分[M(P₂₅, P₇₅), 分]	15.0(8.0, 20.5)	15.0(7.3, 30.0)	-0.532^a	0.595	16.0(9.8, 22.8)	14.5(6.8, 29.5)	-0.612^a	0.541
术后(7±2)d NIHSS评分[M(P₂₅, P₇₅), 分]	5.0(2.0, 13.0)	5.0(2.0, 19.5)	-0.198^a	0.843	6.5(3.0, 15.0)	5.5(0.8, 23.8)	-0.602^a	0.547
临床结局[例(%)]
预后良好	35(37.2)	71(41.5)	0.464^b	0.496	17(25.4)	26(38.8)	2.774^b	0.096
中重度残疾	40(42.6)	44(25.7)	7.928^b	0.005	32(47.8)	16(23.9)	8.310^b	0.004
死亡	19(20.2)	56(32.8)	4.697^b	0.030	18(26.9)	25(37.3)	1.678^b	0.195
sICH	8(8.5)	22(12.9)	1.146^b	0.284	9(13.4)	9(13.4)	< 0.001^b	0.999
注：^a为Z值，^b为χ²值，^c为t值。

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表 2 影响AIS-LVO患者预后的单因素logistic回归分析

Table 2. Univariate logistic regression analysis of factors influencing prognosis in AIS-LVO patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄60~80岁	0.129	0.291	19.594	＜0.001	3.630	2.051~6.425
男性	-0.154	0.753	0.368	0.544	0.858	0.522~1.409
发病时间4.5~6.0 h	-0.216	0.299	0.522	0.470	0.806	0.449~1.447
TOAST分型
大动脉粥样硬化性	-0.485	0.258	3.516	0.061	0.616	0.371~1.022
入院NIHSS评分	0.086	0.024	12.973	＜0.001	1.090	1.040~1.142
发病前mRS评分	0.139	0.377	0.136	0.713	1.149	0.548~2.407
入院mRS评分	0.065	0.174	0.141	0.707	1.068	0.759~1.502
DPT	＜0.001	0.002	0.009	0.923	1.000	0.996~1.005
高血压史	-0.283	0.275	1.060	0.303	0.753	0.439~1.292
糖尿病史	0.911	0.347	6.878	0.009	2.486	1.259~4.909
冠心病史	0.265	0.281	0.886	0.346	1.303	0.751~2.263
房颤史	0.807	0.257	9.838	0.002	2.241	1.353~3.710
注：各变量赋值如下，年龄＜60岁=0，60~80岁=1；女性=0，男性=1；发病时间≤4.5 h=0，4.5~6.0 h=1；TOAST分型，心源性=0，大动脉粥样硬化性=1；高血压、糖尿病、冠心病、房颤史，无=0，有=1；入院NIHSS评分、发病前mRS评分、入院mRS评分、DPT均以实际值赋值。

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表 3 影响AIS-LVO患者预后的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of factors influencing prognosis in AIS-LVO patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄60~80岁	1.230	0.325	14.305	＜0.001	3.421	1.809~6.471
入院NIHSS评分	0.067	0.026	6.764	0.009	1.069	1.017~1.124
房颤史	0.428	0.295	2.099	0.147	1.534	0.860~2.736
糖尿病史	1.179	0.384	9.412	0.002	3.252	1.531~6.908

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