Abstract:

Objective: To explore predictive efficiency of amplitude integrated electroencephalography (aEEG) combined with heart rate variability (HRV) parameters in early prognosis of acute ischemic stroke patients after mechanical thrombectomy. Methods: A total of 137 patients with acute ischemic stroke undergoing mechanical thrombectomy in He'nan Provincial People's Hospital were enrolled as the research objects between April 2021 and August 2024. According to 90 d prognosis by modified Rankin Scale (mRS), they were divided into good prognosis group (mRS score ≤ 2, n=77) and poor prognosis group (mRS score > 2, n=60). The clinical data (sociodemographic data, laboratory examination data at admission) were collected, preoperative aEEG data were collected to obtain aEEG score. After admission dynamic ECG examination was performed to obtain HRV parameters [standard deviation of normal R-R intervals (SDNN), standard deviation of normal R-R intervals index (SDNN index), root mean square successive difference of normal R-R intervals (RMSSD), and percentage of normal-to-normal intervals differing by more than 50 ms (pNN50)]. The influencing factors of early prognosis in acute ischemic stroke patients after mechanical thrombectomy were screened by univariate and multivariate Logistic regression analyses, and predictive efficiency of aEEG score and HRV parameters of early prognosis in acute ischemic stroke patients after mechanical thrombectomy was evaluated by area under the curve (AUC) of receiver operating characteristic (ROC) curve. Results: Multivariate Logistic regression analysis showed that higher National Institutes of Health Stroke Scale (NIHSS) score (OR=1.779, 95%CI: 1.038-3.050; P=0.037), higher neutrophil-to-lymphocyte ratio (OR=1.718, 95%CI: 1.016-2.905; P=0.044), and higher aEEG score (OR=1.933, 95%CI: 1.071-3.487; P=0.029) were risk factors for early poor prognosis in acute ischemic stroke patients after mechanial thrombectomy, while higher SDNN (OR=0.908, 95%CI: 0.864-0.953; P=0.000) and higher pNN50 (OR=0.930, 95%CI: 0.866-0.998; P=0.043) were protective factors for good prognosis. The AUC values of aEEG score, SDNN, SDNN index, RMSSD and pNN50 for predicting early poor prognosis were 0.673, 0.685, 0.685, 0.734 and 0.774, respectively. AUC of combined detection was 0.882, greater than those of single index (Z=4.742, P=0.000; Z=4.346, P=0.000; Z=4.360, P=0.000; Z=3.726, P=0.000; Z=2.776, P=0.006). Conclusions: aEEG score combined with HRV parameters have high predictive efficiency for early prognosis in acute ischemic stroke patients after mechanical thrombectomy, which can assist clinical determination.

Key words: Ischemic stroke, Thrombectomy, Electroencephalography, Heart rate, Prognosis, Risk factors, Logistic models, ROC curve

摘要：

目的: 探究振幅整合脑电图（aEEG）联合心率变异性（HRV）参数对急性缺血性卒中患者机械取栓术后早期预后的预测价值。方法: 选择2021年4月至2024年8月于河南省人民医院接受机械取栓术的137例急性缺血性卒中患者，采用改良Rankin量表（mRS）评估术后90 d预后，将患者分为预后良好组（mRS评分≤ 2分，77例）和预后不良组（mRS评分> 2分，60例）。收集患者社会人口学资料、入院时实验室检查等临床资料；收集术前aEEG数据并获得aEEG评分；入院后行动态心电图监测并获得心率变异性参数包括24 h全部窦性R-R间期的标准差（SDNN）、正常R-R间期标准差的均值（SDNN index）、24 h全部相邻窦性R-R间期差值的均方根值（RMSSD）、NN50占全部窦性心搏数的百分比（pNN50）。采用单因素和多因素Logistic回归分析筛查急性缺血性卒中患者机械取栓术后早期预后的影响因素，绘制受试者工作特征曲线并计算曲线下面积评估aEEG评分和心率变异性参数对机械取栓术后早期预后的预测效能。结果: 多因素Logistic回归分析显示，入院时美国国立卫生研究院卒中量表评分（OR=1.779，95% CI：1.038~3.050；P=0.037）、中性粒细胞/淋巴细胞比值（OR=1.718，95% CI：1.016~2.905；P=0.044）和aEEG评分（OR=1.933，95% CI：1.071~3.487；P=0.029）较高是急性缺血性卒中患者机械取栓术后早期预后不良的危险因素，而SDNN（OR=0.908，95% CI：0.864~0.953；P=0.000）和pNN50（OR=0.930，95% CI：0.866~0.998；P=0.043）较高是术后早期预后良好的保护因素。aEEG评分、SDNN、SDNN index、RMSSD、pNN50预测机械取栓术后早期预后的曲线下面积分别为0.673、0.685、0.685、0.734、0.774，上述指标联合预测的曲线下面积为0.882，均高于单一指标预测效能（Z=4.742，P=0.000；Z=4.346，P=0.000；Z=4.360，P=0.000；Z=3.726，P=0.000；Z=2.776，P=0.006）。结论: aEEG评分联合心率变异性参数对急性缺血性卒中患者机械取栓术后早期预后具有较高的预测效能，可用于辅助临床判断。

关键词: 缺血性卒中, 血栓切除术, 脑电描记术, 心率, 预后, 危险因素, Logistic模型, ROC曲线