目的 探讨前循环急性脑梗死（acute cerebral in-farction,ACI）患者支架取栓术后转归的因素及对脂肪特异性丝氨酸蛋白酶抑制剂（visceral adipose tissue-derived serine proteinase inhibitor,Vaspin）、爱帕琳肽（Apelin）水平的影响。方法 选取2022年3月—2025年3月我院接受支架取栓术的112例前循环ACI患者作为研究对象,术后3个月采用改良Rankin量表评分评估转归情况,根据术后转归分为转归良好组（73例）、转归不良组（39例）。比较两组患者的一般资料,分析前循环ACI支架取栓术后转归的影响因素,比较两组血清Vaspin、Apelin水平,并评估其对术后转归的预测效能。结果 两组年龄、入院美国国立卫生院卒中量表（national institutes health stroke scale,NIHSS）评分、入院Alberta卒中项目早期CT（alberta stroke program early CT score,ASPECT）评分、闭塞部位、术后血流完全再通、术后脑出血比较,差异具有统计学意义;年龄、入院NIHSS评分是前循环ACI患者支架取栓术后转归不良的危险因素,入院ASPECT评分、术后血流完全再通是前循环ACI患者支架取栓术后转归不良的保护因素;转归不良组血清Vaspin、Apelin水平均低于转归良好组;受试者工作特征曲线（receiver operating characteristic curve,ROC）评估上述因素对前循环ACI患者支架取栓术后转归不良的预测效能,显示上述因素联合检测的AUC值最大。结论 前循环ACI支架取栓术后转归不良的因素为年龄、入院NIHSS评分,而入院ASPECT评分、术后血流完全再通为保护因素,这些因素结合血清Vaspin、Apelin水平有助于提高患者术后转归不良的预测效能。
Abstract
Objective To explore the factors influencing the prognosis of patients with anterior circulation acute cerebral infarction (ACI) after stent thrombectomy and the effects on the levels of visceral adipose tissue-derived serine proteinase inhibitor (Vaspin) and Apelin. Methods 112 patients with anterior circulation acute cerebral infarction who underwent stent thrombectomy in our hospital from March 2022 to March 2025 were selected as the research subjects. The modified Rankin Scale score was used to evaluate the outcome 3 months after the operation. The patients were divided into the good outcome group (73 cases) and the poor outcome group (39 cases) based on the postoperative outcome. Compare the general data of the two groups, analyze the influencing factors of the outcome after anterior circulation ACI stent thrombectomy, compare the serum levels of Vaspin and Apelin in the two groups, and analyze the predictive efficacy on the postoperative outcome of patients. Results There were statistically significant differences between the two groups in terms of age, NIHSS score at admission, ASPECT score at admission, occlusion site, complete postoperative blood flow reperfusion, and postoperative cerebral hemorrhage. Age and the NIHSS score on admission are risk factors for poor outcomes after stent retriever thrombectomy in patients with anterior circulation acute ischemic stroke. The ASPECT score on admission and complete reperfusion of blood flow post-procedure are protective factors against poor outcomes in these patients; The serum levels of Vaspin and Apelin in the poor outcome group were lower than those in the good outcome group. The receiver operating characteristic curve (ROC) evaluated the predictive performance of the aforementioned factors for poor outcomes after stent retriever thrombectomy in patients with anterior circulation acute cerebral infarction, showing that the combined detection of these factors yielded the largest area under the curve (AUC). Conclusion Factors associated with poor post-procedural outcomes after anterior circulation acute ischemic stroke thrombectomy include age and admission NIHSS score, whereas admission ASPECTS score and complete reperfusion post-procedure are protective factors. Combining these factors with serum Vaspin and Apelin levels can enhance the predictive accuracy for poor post-procedural outcomes in patients.
关键词
前循环 /
急性脑梗死 /
支架取栓术 /
转归 /
脂肪特异性丝氨酸蛋白酶抑制剂 /
爱帕琳肽
Key words
anterior circulation /
acute cerebral infarction /
stent thrombectomy /
outcome /
fatty-specific serine protease inhibitor /
aApelin peptide
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基金
贵港市科技计划项目 “高危房颤合并重度颅内动脉狭窄的脑梗死患者不同抗栓方案比较”（贵科攻2100050）
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