Application of quantitative electroencephalography in prognosis prediction after mechanical thrombectomy in acute ischemic stroke

doi:10.3969/j.issn.1672-6731.2023.11.014

Abstract

Abstract:

Objective: To explore the clinical application of quantitative electroencephalography (qEEG) in predicting the early prognosis of acute ischemic stroke after mechanical thrombectomy. Methods: A total of 71 patients who underwent acute ischemic stroke mechanical thrombectomy from April 2021 to September 2022 were enrolled in He'nan Provincial People's Hospital, all of them performed qEEG after surgery. Modified Rankin Scale (mRS) was used to evaluate the prognosis on the 90 d after the surgery. Univariate and multivariate backward Logistic regression analyses were used to screen risk factors for prognosis in acute ischemic stroke after mechanical thrombectomy. Receiver operating characteristic (ROC) curve was used to predict the value of qEEG for the prognosis of neural function. Results: Patients in dismal prognosis group (mRS score 3-5, n=28) had higher NIHSS score at admission (t=2.686, P=0.009), higher proportion of thrombectomy performed more than 3 times (χ²=4.201, P=0.040), higher values of DTABR on the affected side (t=2.183, P=0.032), higher ratio of DTABR on affected side/unaffected side (t=6.230, P=0.000), and higher proportion of immediately Thrombolysis in Cerebral Infarction (TICI) < 2b after surgery (χ²=5.420, P=0.020) compared to favorable prognosis group (mRS score 0-2, n=43). Logistic regression analysis showed higher NIHSS score at admission (OR=1.542, 95%CI: 1.368-1.725; P=0.012), DTABR on affected side/unaffected side (OR=3.428, 95%CI: 2.673-7.314; P=0.008), percent alpha variability (PAV) grade Ⅱ (OR=2.983, 95%CI: 2.625-4.682; P=0.003) and grade Ⅲ (OR=4.088, 95%CI: 3.825-5.349; P=0.002), amplitude electroencephalography (aEEG) grade Ⅱ (OR=2.536, 95%CI: 1.942-5.287; P=0.005) and grade Ⅲ (OR=3.924, 95%CI: 2.012-6.378; P=0.003) were risk factors of dismal prognosis in acute ischemic stroke after mechanical thrombectomy. ROC curve showed the area under the curve (AUC) of NIHSS score was 0.676 (95%CI: 0.554-0.782, P=0.000), DTABR on affected side/unaffected side was 0.887 (95%CI: 0.789-0.950, P=0.000), the PAV was 0.760 (95%CI: 0.643-0.853, P=0.000), aEEG was 0.778 (95%CI: 0.664-0.868, P=0.000), and the combined indicators classification was 0.943 (95%CI: 0.861-0.984, P=0.000). Among them, the predictive power of the combined indicators is higher than that of the NIHSS score at admission (Z=4.150, P=0.000), PAV (Z=4.006, P=0.000) and aEEG (Z=3.462, P=0.001). Conclusions: qEEG is an effective method to predict the early prognosis of acute ischemic stroke after mechanical thrombectomy.

Key words: Ischemic stroke, Mechanical thrombolysis, Electroencephalography, Risk factors, Logistic models, ROC curve

摘要：

目的: 探讨定量脑电图对急性缺血性卒中血管内机械取栓术后神经功能预后的预测价值。方法: 纳入2021年4月至2022年9月在河南省人民医院行血管内机械取栓术的71例急性缺血性卒中患者，术后均行定量脑电图监测，术后90 d采用改良Rankin量表（mRS）评价神经功能预后，单因素和多因素Logistic回归分析筛查术后神经功能预后不良危险因素，绘制受试者工作特征（ROC）曲线评价筛选出的危险因素预测术后神经功能预后不良的效能。结果: 预后不良组（mRS评分3~5分，28例）入院时美国国立卫生研究院卒中量表（NIHSS）评分（t=2.686，P=0.009）、取栓次数> 3次比例（χ²=4.201，P=0.040）、患侧脑电图慢波化指数（DTABR；t=2.183，P=0.032）、患侧DTABR/健侧DTABR比值（t=6.230，P=0.000）、术后即刻脑梗死溶栓血流分级 < 2b级比例（χ²=5.420，P=0.020）均高于预后良好组（mRS评分0~2分，43例）。Logistic回归分析显示，入院时高NIHSS评分（OR=1.542，95%CI：1.368~1.725；P=0.012）、高患侧DTABR/健侧DTABR比值（OR=3.428，95%CI：2.673~7.314；P=0.008）、相对α变异性（PAV）Ⅱ级（OR=2.983，95%CI：2.625~4.682；P=0.003）和Ⅲ级（OR=4.088，95%CI：3.825~5.349；P=0.002）、振幅整合脑电图（aEEG）Ⅱ级（OR=2.536，95%CI：1.942~5.287；P=0.005）和Ⅲ级（OR=3.924，95%CI：2.012~6.378；P=0.003）是急性缺血性卒中机械取栓术后预后不良的危险因素。ROC曲线显示，入院时NIHSS评分、患侧DTABR/健侧DTABR比值、PAV分级、aEEG分级及其联合指标预测急性缺血性卒中机械取栓术后预后不良的曲线下面积分别为0.676（95%CI：0.554~0.782，P=0.000）、0.887（95%CI：0.789~0.950，P=0.000）、0.760（95%CI：0.643~0.853，P=0.000）、0.778（95%CI：0.664~0.868，P=0.000）和0.943（95%CI：0.861~0.984，P=0.000）。其中，联合指标的预测效能高于单独应用入院时NIHSS评分（Z=4.150，P=0.000）、PAV分级（Z=4.006，P=0.000）和aEEG分级（Z=3.462，P=0.001）。结论: 定量脑电图对早期预测急性缺血性卒中血管内机械取栓术后神经功能预后具有重要应用价值。

关键词: 缺血性卒中, 机械溶栓, 脑电描记术, 危险因素, Logistic模型, ROC曲线

Bing-sha HAN, Jiao LI, Yan-ru LI, Ju WANG, Zhi-qiang REN, Guang FENG. Application of quantitative electroencephalography in prognosis prediction after mechanical thrombectomy in acute ischemic stroke[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(11): 1043-1051.

韩冰莎, 李娇, 栗艳茹, 王炬, 任志强, 冯光. 定量脑电图在急性缺血性卒中血管内机械取栓术后预后预测中的应用[J]. 中国现代神经疾病杂志, 2023, 23(11): 1043-1051.

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References 48

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观察指标	预后良好组（n = 43）	预后不良组（n = 28）	统计量值	P值	观察指标	预后良好组（n = 43）	预后不良组（n = 28）	统计量值	P值
性别[例（%）]			0.012	0.912	手术方式[例（%）]			0.043	0.979
男性	24（55.81）	16（57.14）			支架取栓术	9（20.93）	6（21.43）
女性	19（44.19）	12（42.86）			抽吸取栓术	13（30.23）	9（32.14）
年龄（$\bar x \pm s$，岁）	62.21 ± 11.11	63.93 ± 10.03	0.662	0.510	支架取栓术+ 抽吸取栓术	21（48.84）	13（46.43）
入院时NIHSS（$\bar x \pm s$，评分）	19.86 ± 3.27	22.07 ± 3.57	2.686	0.009	TICI分级＜2b级[例（%）]	10（23.26）	14（50.00）	5.420	0.020
入院时mRS（$\bar x \pm s$，评分）	3.72 ± 0.63	3.79 ± 0.69	-0.409	0.684	DTABR（$\bar x \pm s$）
高血压[例（%）]	28（65.12）	20（71.43）	0.309	0.579	患侧	2.91 ± 1.34	3.53 ± 0.88	2.183	0.032
糖尿病[例（%）]	11（25.58）	6（21.43）	0.161	0.689	健侧	1.64 ± 0.43	1.77 ± 0.35	0.974	0.334
房颤[例（%）]	14（32.56）	10（35.71）	0.075	0.784	患侧/健侧比值	1.18 ± 0.20	2.16 ± 0.31	6.230	0.000
吸烟[例（%）]	19（44.19）	12（42.86）	0.012	0.912	PAV分级[例（%）]			-4.317	0.000
饮酒[例（%）]	17（39.53）	11（39.29）	0.000	0.983	Ⅰ级	28（65.12）	4（14.29）
颅内动脉闭塞部位[例（%）]			1.232	0.540	Ⅱ级	13（30.23）	17（60.71）
颈内动脉	12（27.91）	5（17.86）			Ⅲ级	2（4.65）	7（25.00）
大脑中动脉	18（41.86）	15（53.57）			aEEG分级[例（%）]			-4.434	0.000
椎基底动脉	13（30.23）	8（28.57）			Ⅰ级	31（72.10）	6（21.43）
取栓次数> 3次[例（%）]	14（32.56）	16（57.14）	4.201	0.040	Ⅱ级	12（27.91）	17（60.71）
发病至血管再通时间（$\bar x \pm s$，min）	238.28 ± 64.13	259.57 ± 63.43	1.373	0.174	Ⅲ级	0（0.00）	5（17.86）
手术至血管再通时间（$\bar x \pm s$，min）	61.58 ± 14.08	66.71 ± 11.20	1.623	0.109

观察指标	预后良好组（n = 43）	预后不良组（n = 28）	统计量值	P值	观察指标	预后良好组（n = 43）	预后不良组（n = 28）	统计量值	P值
性别[例（%）]			0.012	0.912	手术方式[例（%）]			0.043	0.979
男性	24（55.81）	16（57.14）			支架取栓术	9（20.93）	6（21.43）
女性	19（44.19）	12（42.86）			抽吸取栓术	13（30.23）	9（32.14）
年龄（$\bar x \pm s$，岁）	62.21 ± 11.11	63.93 ± 10.03	0.662	0.510	支架取栓术+ 抽吸取栓术	21（48.84）	13（46.43）
入院时NIHSS（$\bar x \pm s$，评分）	19.86 ± 3.27	22.07 ± 3.57	2.686	0.009	TICI分级＜2b级[例（%）]	10（23.26）	14（50.00）	5.420	0.020
入院时mRS（$\bar x \pm s$，评分）	3.72 ± 0.63	3.79 ± 0.69	-0.409	0.684	DTABR（$\bar x \pm s$）
高血压[例（%）]	28（65.12）	20（71.43）	0.309	0.579	患侧	2.91 ± 1.34	3.53 ± 0.88	2.183	0.032
糖尿病[例（%）]	11（25.58）	6（21.43）	0.161	0.689	健侧	1.64 ± 0.43	1.77 ± 0.35	0.974	0.334
房颤[例（%）]	14（32.56）	10（35.71）	0.075	0.784	患侧/健侧比值	1.18 ± 0.20	2.16 ± 0.31	6.230	0.000
吸烟[例（%）]	19（44.19）	12（42.86）	0.012	0.912	PAV分级[例（%）]			-4.317	0.000
饮酒[例（%）]	17（39.53）	11（39.29）	0.000	0.983	Ⅰ级	28（65.12）	4（14.29）
颅内动脉闭塞部位[例（%）]			1.232	0.540	Ⅱ级	13（30.23）	17（60.71）
颈内动脉	12（27.91）	5（17.86）			Ⅲ级	2（4.65）	7（25.00）
大脑中动脉	18（41.86）	15（53.57）			aEEG分级[例（%）]			-4.434	0.000
椎基底动脉	13（30.23）	8（28.57）			Ⅰ级	31（72.10）	6（21.43）
取栓次数> 3次[例（%）]	14（32.56）	16（57.14）	4.201	0.040	Ⅱ级	12（27.91）	17（60.71）
发病至血管再通时间（$\bar x \pm s$，min）	238.28 ± 64.13	259.57 ± 63.43	1.373	0.174	Ⅲ级	0（0.00）	5（17.86）
手术至血管再通时间（$\bar x \pm s$，min）	61.58 ± 14.08	66.71 ± 11.20	1.623	0.109

变量	赋值
变量	0	1	2
性别	女性	男性
高血压	否	是
糖尿病	否	是
房颤	否	是
吸烟	否	是
饮酒	否	是
颅内动脉闭塞部位	颈内动脉	大脑中动脉	椎基底动脉
手术方式	支架取栓术	抽吸取栓术	支架取栓术+ 抽吸取栓术
取栓次数>3次	否	是
TICI分级＜2b级	否	是
PAV分级	Ⅰ级	Ⅱ级	Ⅲ级
aEEG分级	Ⅰ级	Ⅱ级	Ⅲ级

变量	赋值
变量	0	1	2
性别	女性	男性
高血压	否	是
糖尿病	否	是
房颤	否	是
吸烟	否	是
饮酒	否	是
颅内动脉闭塞部位	颈内动脉	大脑中动脉	椎基底动脉
手术方式	支架取栓术	抽吸取栓术	支架取栓术+ 抽吸取栓术
取栓次数>3次	否	是
TICI分级＜2b级	否	是
PAV分级	Ⅰ级	Ⅱ级	Ⅲ级
aEEG分级	Ⅰ级	Ⅱ级	Ⅲ级

变量	b	SE	Wald χ²	P值	OR值	OR 95%CI
年龄	-0.039	0.032	1.493	0.222	1.040	0.977 ~ 1.106
男性	0.479	0.492	0.947	0.330	1.614	0.615 ~ 4.233
入院时NIHSS评分	0.207	0.076	7.323	0.007	1.229	1.059 ~ 1.428
入院时mRS评分	0.726	4.929	5.357	0.481	1.268	0.753 ~ 3.682
高血压	0.223	0.531	0.176	0.674	1.250	0.441 ~ 3.540
糖尿病	-0.263	0.579	0.207	0.649	0.769	0.247 ~ 2.391
房颤	0.105	0.513	0.042	0.837	1.111	0.407 ~ 3.034
吸烟	0.119	0.529	0.094	0.803	1.137	0.305 ~ 3.166
饮酒	0.273	0.513	1.029	0.792	1.314	0.187 ~ 8.220
大脑中动脉闭塞	0.693	0.637	1.085	0.276	2.000	0.574 ~ 6.968
椎基底动脉闭塞	0.470	0.701	0.449	0.503	1.600	0.405 ~ 6.324
抽吸取栓术	0.038	0.683	0.003	0.956	1.035	0.273 ~ 3.957
支架取栓术+抽吸取栓术	-0.074	0.634	0.018	0.907	0.927	0.268 ~ 3.214
取栓次数>3次	0.673	0.495	1.853	0.043	1.126	1.244 ~ 2.170
发病至血管再通时间	0.864	0.540	2.564	0.109	0.421	0.146 ~ 1.214
手术至血管再通时间	0.011	0.008	1.651	0.199	1.011	0.994 ~ 1.328
TICI分级＜2b级	0.006	0.003	4.107	0.033	1.006	1.000 ~ 1.056
患侧DTABR	3.857	1.177	10.733	0.039	2.320	1.709 ~ 2.547
健侧DTABR	0.355	0.412	0.739	0.390	1.426	0.635 ~ 3.200
患侧DTABR/健侧DTABR比值	2.608	0.632	17.026	0.003	4.578	3.933 ~ 9.873
PAVⅡ级	2.214	0.649	11.632	0.002	2.854	2.565 ~ 3.674
PAVⅢ级	3.892	1.195	10.602	0.001	4.908	4.708 ~ 6.007
aEEGⅡ级	2.078	0.590	12.379	0.004	3.985	2.510 ~ 7.403
aEEGⅢ级	2.845	0.974	13.412	0.000	4.462	2.945 ~ 8.256

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