[1]高宇,李子昂,张健,等.不同侧支循环状态下直接取栓与桥接取栓治疗急性前循环大血管闭塞性脑卒中疗效及安全性比较[J].新乡医学院学报,2024,(2):169-174.[doi:10.7683/xxyxyxb.2024.02.012]
　GAO Yu,LI Ziang,ZHANG Jian,et al.Comparison of efficacy and safety of direct thrombectomy and bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke under different collateral circulation statuses[J].Journal of Xinxiang Medical University,2024,(2):169-174.[doi:10.7683/xxyxyxb.2024.02.012]
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不同侧支循环状态下直接取栓与桥接取栓治疗急性前循环大血管闭塞性脑卒中疗效及安全性比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年2
页码:
169-174
栏目:
临床研究
出版日期:
2024-02-05

文章信息/Info

Title:
Comparison of efficacy and safety of direct thrombectomy and bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke under different collateral circulation statuses
文章编号:
20240212
作者:
高宇1; 李子昂1; 张健1; 刘韩鹏1; 张平2; 闫瑞芳3; 岳军艳4; 崔红凯1
（1.新乡医学院第一附属医院神经介入科，河南　卫辉　453100；2.新乡医学院第一附属医院神经内科，河南　卫辉　453100；3.新乡医学院第一附属医院磁共振科，河南　卫辉　453100；4.新乡医学院第一附属医院放射科，河南　卫辉　453100）
Author(s):
GAO Yu1 ; LI Zi′ang1 ; ZHANG Jian1; LIU Hanpeng1; ZHANG Ping2; YAN Ruifang3; YUE Junyan4; CUI Hongkai1
(1.Department of Neurointervention,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China;2.Department of Neurology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China;3.Department of Magnetic Resonance Imaging,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China;4.Department of Radiology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,China)
关键词:
妊娠期糖尿病; 妊娠早期; 空腹血糖; 白细胞计数; 血脂
Keywords:
stroke; collateral circulation; direct thrombectomy; bridging thrombectomy
分类号:
R743.3
DOI:
10.7683/xxyxyxb.2024.02.012
文献标志码:
A
摘要:
目的　探讨妊娠早期（孕6~13+6周）孕妇血炎症指标、空腹血糖及血脂与妊娠期糖尿病（GDM）的关系。
方法　选择2020年11月至2021年10月在新乡医学院第一附属医院进行产检的98例妊娠早期孕妇为研究对象，依据受试者妊娠中期（孕24~28周）的口服葡萄糖耐量试验结果将其分为GDM组（n=35）和糖耐量正常（NGT）组（n=63）。所有受试者于孕6~13+6周时空腹8 h以上，于第2天清晨抽取肘正中静脉血，测定白细胞（WBC）计数、中性粒细胞计数（NC）、淋巴细胞计数（LC）、单核细胞计数（MC）、空腹血糖（FPG）及血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平，比较GDM组与NGT组孕妇各指标之间的差异。应用多因素logistic回归模型寻求联合预测因子并进行GDM发生的独立危险因素分析，采用受试者操作特征（ROC）曲线评估各危险因素预测GDM发生的效能。
结果　GDM组孕妇妊娠早期FPG、WBC计数、LC、TC、TG、LDL-C水平显著高于NGT组（P<0.05）；GDM组与NGT组孕妇的NC、MC及HDL-C水平比较差异无统计学意义（P>0.05）。Logistic回归模型分析显示， FPG、WBC计数、TC、TG升高是GDM发生的独立危险因素（P<0.05）。以FPG=4.80 mmol·L-1、WBC=9.35×109 L-1、TC=4.05 mmol·L-1、TG=1.61 mmol·L-1为截断值，预测GDM的ROC曲线下面积（AUC）分别为0.779、0.721、0.685、0.762，敏感度分别为0.886、0.514、0.857、0.543，特异度分别为0.587、0.857、0.524、0.873，四者联合预测GDM的AUC为0.876，灵敏度为0.857，特异度为0.810。妊娠早期FPG、WBC计数、TC、TG联合预测GDM的AUC高于FPG、WBC、TC、TG单独预测GDM的AUC。
结论　妊娠早期（孕6~13+6周）孕妇血FPG、WBC计数、TC、TG是GDM的独立危险因素，可作为早期预测GDM发生的临床指标，且4项指标联合对GDM有更好的预测价值。
Abstract:
Objective　To compare the safety and efficacy of direct thrombectomy versus bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke under different collateral circulation statuses.
Methods　Totally 93 patients with acute anterior circulation ischemic stroke admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2020 to March 2023 were selected as the research subjects.Patients were divided into direct thrombectomy group (n=47) and bridging thrombectomy group (n=46) based on the type of thrombectomy.Patients in the direct thrombectomy group received direct intravascular thrombectomy,while patients in the bridging thrombectomy group received intravenous thrombolysis with alteplase combined with mechanical thrombectomy.According computed tomography angiography,the collateral circulation Tan classification was applied to divide the patients into good collateral circulation sub-group and poor collateral circulation sub-group.The modified thrombolysis in cerebral infarction grading (mTICI) was used to evaluate vessel recanalization.Head computed tomography plain scan was performed at 24-48 hours postoperatively to assess if there was hemorrhagic transformation,and modified Rankin Scale score was performed at 90 days postoperatively.Information such as imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,prognosis and spontaneous non-traumatic symptomatic intracerebral hemorrhage (SICH) were collected.
Results　The age,gender,baseline Alberta stroke program early computed tomography score,baseline national institutes of health stroke scale score,proportions of hypertension,diabetes and atrial fibrillation,baseline systolic pressure,creatinine,baseline blood glucose,platelet count,occlusion site,stroke etiologies and collateral circulation status of patients in the two groups were not statistically significantly different (P>0.05).There were no significant differences in the post-admission imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,successful vascular reperfusion rate,good prognosis rate,mortality rate,and SICH incidence between the two groups (P>0.05).The hemorrhagic transformation rate of patients in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group (P<0.05).There were no significant differences in the post-admission imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,successful vascular reperfusion rate,good prognosis rate,mortality rate,and SICH incidence between patients with good collateral circulation and patients with poor collateral circulation in the two groups (P>0.05).The hemorrhagic transformation rate of patients with good and poor collateral circulation in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group (P<0.05).
Conclusion　Under different collateral circulation conditions,the safety and efficacy of direct thrombectomy and bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke are similar,but bridging thrombectomy is more likely to result in cerebral hemorrhage transformation compared with direct thrombectomy.

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更新日期/Last Update: 2024-02-27