摘要：

目的 筛查急性前循环缺血性卒中静脉溶栓预后相关影响因素，并探讨基于CTA 的两种侧支循环评价量表对急性前循环缺血性卒中静脉溶栓预后的预测能力。方法 连续纳入136 例急性缺血性卒中患者，均予重组组织型纤溶酶原激活物静脉溶栓，采用基于CTA 的区域软脑膜侧支循环评分（rLMC）和Tan 侧支循环评分（Tan）评价侧支循环，发病后3 个月采用改良Rankin 量表评价预后（以病残或病死为主要结局指标）。单因素和多因素逐步法Logistic 回归分析筛查急性前循环缺血性卒中静脉溶栓预后不良相关危险因素，受试者工作特征（ROC）曲线评价Tan 评分对急性前循环缺血性卒中静脉溶栓预后的预测能力。结果 最终纳入122 例行静脉溶栓治疗的急性前循环缺血性卒中患者，Logistic 回归分析显示，发病至静脉溶栓时间180 ~ 270 min（OR = 0.309，95%CI：0.134 ~ 0.713；P = 0.006）和Tan 评分0 ~ 1 分（OR = 7.339，95%CI：2.072 ~ 25.994；P = 0.002）是急性前循环缺血性卒中静脉溶栓预后不良的独立危险因素。Tan 评分预测急性前循环缺血性卒中静脉溶栓预后的ROC 曲线显示，曲线下面积为0.753（P = 0.021）。结论 发病至静脉溶栓时间180 ~ 270 min 和Tan 评分0 ~ 1 分是急性前循环缺血性卒中静脉溶栓预后不良的独立危险因素。与rLMC 评分相比，Tan 评分是一种相对简单且预测能力较好的侧支循环评价量表。

关键词: 卒中, 脑缺血, 血栓溶解疗法, 侧支循环, 回归分析

Abstract:

Objective  To screen the related influencing factors of prognosis in acute anterior ischemic stroke patients who underwent intravenous thrombolysis, and to explore the predictive ability of two collateral scores based on CT angiography (CTA).  Methods  A total of 136 patients with acute ischemic stroke were treated by recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis. Regional Lepomeningeal Collateral Score (rLMC) and Tan Collateral Score (Tan) based on CTA were used to assess the collateral status. Modified Rankin Scale (mRS) was used to evaluate the prognosis (death or disability as main outcome indicators) 3 months after onset. Univariate and multivariate stepwise Logistic regression analysis was used to screen related risk factors for poor prognosis of intravenous thrombolysis in acute anterior ischemic stroke. Receiver operating characteristic (ROC) curve was used to evaluate predictive ability of Tan score on the prognosis of intravenous thrombolysis in acute anterior ischemic stroke.  Results  Among 136 cases, 122 patients with acute anterior ischemic stroke who underwent rt-PA intravenous thrombolysis were finally included. Logistic regression analysis showed time from onset to intravenous thrombolysis (180-270 min; OR = 0.309, 95%CI: 0.134-0.713, P = 0.006) and Tan (0-1 score; OR = 7.339, 95%CI: 2.072-25.994, P = 0.002) was independent risk factors for poor prognosis of intravenous thrombolysis in acute anterior ischemic stroke. ROC curve of Tan score predicting the prognosis of intravenous thrombolysis in acute anterior ischemic stroke indicated that area under the curve (AUC) was 0.753 (P = 0.021).  Conclusions Time from onset to intravenous thrombolysis (180-270 min) and Tan score (0-1 score) are independent risk factors for poor prognosis of intravenous thrombolysis in acute anterior ischemic stroke. Compared with rLMC score, Tan score is a simple and reliable collateral status evaluation system.

Key words: Stroke, Brain ischemia, Thrombolytic therapy, Collateral circulation, Regression analysis