摘要
目的 探索大核心梗死急性缺血性卒中(AIS)患者接受血管内治疗后获得良好预后的预测因素。方法 纳入急性缺血卒中早期治疗前瞻性多中心队列(MAGIC)登记研究数据库中2021年11月1日～2023年2月8日接受治疗的大核心梗死AIS患者490例,根据90天改良Rankin评分量表(mRS)评分将其分为良好预后组(181例,mRS评分≤3分)和不良预后组(309例,mRS评分>3分)。比较两组患者的一般资料及临床资料。采用多因素logistic回归分析评估影响接受血管内治疗的大核心梗死AIS患者90天良好预后的影响因素。结果 良好预后组年龄、入院收缩压、入院随机血糖、基线美国国立卫生研究院卒中量表(NIHSS)评分、手术时间及房颤、美国介入和治疗神经放射学协会/介入放射学协会(ASITN/SIR)0～1级、心源性栓塞、颈内动脉闭塞、症状性颅内出血患者比例低于不良预后组,基线基于Alberta卒中项目早期CT评分(ASPECTS)及男性、吸烟、ASITN/SIR 2级、ASITN/SIR 3～4级、大动脉粥样硬化型、大脑中动脉M1段闭塞、血管成功再通患者比例均高于不良预后组(P<0.05)。多因素logistic回归分析结果显示,基线ASPECTS、ASITN/SIR 2级、ASITN/SIR 3～4级和血管成功再通均为90天良好预后的保护因素,年龄、入院随机血糖、基线NIHSS评分和症状性颅内出血均为90天良好预后的危险因素(P<0.05)。随着年龄、入院随机血糖、基线NIHSS评分的增加,患者90天良好预后率降低;随着基线ASPECTS的增加,患者90天良好预后率增加。结论 大核心梗死AIS患者接受血管内治疗后良好预后率偏低。年龄、入院随机血糖、基线NIHSS评分、基线ASPECTS、ASITN/SIR 2级、ASITN/SIR 3～4级、血管成功再通和症状性颅内出血是急性大核心梗死接受血管内治疗后获得良好预后的预测因素。
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