摘要：

目的 筛查大脑中动脉狭窄或闭塞致缺血性卒中预后良好的影响因素。方法 共109 例大脑中动脉狭窄或闭塞致缺血性卒中患者，记录性别、年龄、发病至MRI 检查时间、既往史［脑卒中和（或）短暂性脑缺血发作、冠心病、心房颤动和吸烟史、饮酒史］、收缩压和舒张压、血糖、血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、血浆同型半胱氨酸、入院时和出院时美国国立卫生研究院卒中量表（NIHSS）评分、随访3 个月时改良Rankin 量表（mRS）评分，行MRI和三维时间飞跃MRA检查，获得大脑中动脉狭窄率、FLAIR 成像血管高信号（FVH）评分、FVH-扩散加权成像（DWI）不匹配比例、DWI-Alberta脑卒中计划早期CT 评分（ASPECTS），单因素和多因素前进法Logistic回归分析筛查大脑中动脉狭窄或闭塞致缺血性卒中预后良好的影响因素，受试者工作特征（ROC）曲线确定FVH 评分和DWI-ASPECTS 评分预测预后良好的临界值。结果 根据mRS 评分分为预后良好（mRS 评分≤ 2 分）组（24 例）和预后不良（mRS 评分> 2 分）组（85 例）。Logistic 回归分析显示，舒张压（OR = 0.924，95%CI：0.869 ~ 0.983；P = 0.013）、FVH 评分（OR = 2.008，95%CI：1.404 ~ 2.873；P = 0.000）和DWI-ASPECTS 评分（OR = 1.955，95%CI：1.336 ~ 2.862；P = 0.001）是大脑中动脉狭窄或闭塞致缺血性卒中预后良好的独立影响因素。ROC 曲线显示，FVH 评分曲线下面积为0.768（95%CI：0.656 ~ 0.880，P = 0.000），DWI-ASPECTS评分曲线下面积为0.721（95%CI：0.608 ~ 0.834，P = 0.001）；FVH 评分预测预后良好的临界值为4.50 分，其灵敏度为0.625、特异度为0.824、Youden 指数为0.449，DWI-ASPECTS 评分预测预后良好的临界值为6.50 分，其灵敏度为0.750、特异度为0.671、Youden 指数为0.421。结论 大脑中动脉狭窄或闭塞致缺血性卒中预后的独立影响因素包括舒张压、FVH 评分和DWI-ASPECTS 评分，其中，FVH 评分预测预后良好的价值更高。

关键词: 卒中, 脑缺血, 大脑中动脉, 预后, Logistic模型

Abstract:

Objective  To screen related influencing factors for good prognosis of ischemic stroke caused by middle cerebral artery (MCA) stenosis or occlusion. Methods  A total of 109 patients with ischemic stroke caused by MCA stenosis or occlusion were enrolled in this study. Their clinical data were recorded, such as sex, age, time from onset to MRI, history [stroke and/or transient ischemic attack (TIA), coronary heart disease, atrial fibrillation, smoking and drinking], systolic blood pressure (SBP), diastolic blood pressure (DBP), serum glucose, total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), plasma homocysteine (Hcy), National Institutes of Health Stroke Scale (NIHSS) score on admission and discharge, modified Rankin Scale (mRS) at 3-month follow-up. MRI and three-dimensional time-of-flight (3D-TOF) MRA were performed to get MCA stenosis rate, FLAIR vascular hyperintensity (FVH) score, FVH-diffusion-weighted imaging (DWI) mismatching proportion, DWI-Alberta Stroke Program Early CT Score (ASPECTS). Univariate and multivariate forward Logistic regression analysis was used to screen related influencing factors for good prognosis. Receiver operating characteristic (ROC) curve was used to evaluate the accuracy and best threshold of FVH and DWI-ASPECTS scores predicting good prognosis.  Results  According to mRS score, patients were divided into good prognosis group (mRS ≤ 2, N = 24) and poor prognosis group (mRS > 2, N = 85). Logistic regression analysis showed that DBP (OR = 0.924, 95% CI: 0.869-0.983; P = 0.013), FVH score (OR = 2.008, 95% CI: 1.404-2.873; P = 0.000) and DWI-ASPECTS score (OR = 1.955, 95% CI: 1.336-2.862; P = 0.001) were independent influencing factors for good prognosis. ROC curve showed that area under the curve (AUC) of FVH score was 0.768 (95% CI: 0.656-0.880, P = 0.000), AUC of DWI-ASPECTS score was 0.721 (95%CI: 0.608-0.834, P = 0.001). The best threshold of FVH score was 4.50, sensitivity was 0.625, specificity was 0.824, Youden index was 0.449. The best threshold of DWI-ASPECTS score was 6.50, sensitivity was 0.750, specificity was 0.671, Youden index was 0.421.  Conclusions  For ischemic stroke caused by MCA stenosis or occlusion, the related prognostic factors include DBP, FVH score and DWI-ASPECTS score, whereas FVH score has higher accuracy.

Key words: Stroke, Brain ischemia, Middle cerebral artery, Prognosis, Logistic models