急性前循环缺血性卒中血管内治疗术后早期脑血流自动调节功能与预后关系研究

doi:10.3969/j.issn.1673-5765.2020.12.008

摘要/Abstract

摘要：

目的使用传递函数分析（transfer function analysis，TFA）和Spearman相关性分析计算急性前循环缺血性卒中血管内治疗术后患者早期脑血流自动调节（cerebral autoregulation，CA）功能，比较两种方法得出的自动调节参数与临床预后的相关性。方法前瞻性纳入急性前循环缺血性卒中且进行了血管内治疗的患者，收集患者的影像、临床信息。术后48 h内使用TCD联合无创动脉压，连续采集患者双侧大脑中动脉脑血流速度（flow velocity，FV）和逐搏动脉压（arterial blood pressure，ABP）。使用TFA计算FV和ABP信号的极低频（0.02～0.07 Hz）、低频（0.07～0.20 Hz）、高频（0.20～0.50 Hz）的相位差和增益；使用Spearman相关性分析计算平均血流速度指数（mean flow velocity index，Mx）。根据患者90 d mRS评分分为预后良好（mRS≤2分）和预后不良（mRS＞2分），比较不同预后患者上述CA参数的差异，并用多因素分析评估不同方法计算的CA 参数对患者90d预后的影响。另外，分析CA参数与术后7 d NIHSS评分相对术前的改善（ΔNIHSS）、90 d mRS评分、术前梗死体积、术后48 h增加的梗死体积等临床指标的相关性。结果共纳入52例患者，90 d预后良好18例，预后不良34例。与预后良好患者相比，预后不良患者 Mx较高[0.40（0.18～0.50）vs 0.26（0.05～0.36），P =0.012]，但两组各频段相位差和增益的差异均无统计学意义。Mx与术后7 d的ΔNIHSS、90 d mRS评分、术前梗死体积、术后48 h增加的梗死体积均为正相关性（r 值分别为0.299、0.382、0.561和0.286，P值分别为0.031、0.005、<0.001和0.040），极低频相位差与术前梗死体积、90 d mRS评分均呈负相关（r 值分别为-0.282、-0.276，P值分别为0.043、0.048）。多因素回归分析提示Mx值是90 d预后不良的独立影响因素（OR 132.69，95%CI 5.71～3081.96，P =0.002）。结论急性前循环缺血性卒中血管内治疗术后早期CA功能相对保留与预后良好相关。相比于相位差和增益，Mx与90 d临床结局有更强的相关性。

文章导读： 本研究对急性前循环缺血性卒中血管内治疗后患者的CA功能采用了不同方法的指标评价，结果显示Spearman相关性分析计算的Mx能更好地反映患者的90 d预后。

关键词: 脑血流自动调节; 急性缺血性卒中; 血管内治疗; 传递函数; 平均血流速度指数

Abstract:

Objective Using transfer function analysis (TFA) and Spearman correlation analysis to calculate cerebral autoregulation (CA) after endovascular treatment (EVT) in acute anterior circulation ischemic stroke, and to compare the correlation between the CA calculated by the two methods and clinical outcome. Methods The data of acute anterior circulation ischemic stroke patients who received endovascular treatment were prospectively collected. Within 48 hours after EVT, the bilateral middle cerebral artery flow velocity (FV) by TCD and non-invasive arterial blood pressure (ABP) were continuously recorded, TFA was used to calculate phase shift and gain of FV and ABP (including different frequency: very low 0.02-0.07 Hz, low 0.07-0.20 Hz, high 0.20-0.50 Hz), and Spearman correlation analysis was used to calculate mean flow velocity index (Mx). Good prognosis was defined as a mRS score of 0-2. The association of the above CA parameters by two methods with clinical prognosis (including 90-day mRS, NIHSS score decrease at 7 days, pre-EVT infarction volume and infarction volume increase at 48 hours post-EVT) were analyzed. Results A total of 52 patients were included. 18 patients had 90-day good prognosis. The Mx of the patients with poor prognosis was higher than that of the patients with good prognosis [0.40 (0.18, 0.50) vs 0.26 (0.05, 0.36), P =0.012], while there were no statistical differences in phase shift and gain in each frequency band between the two groups. Mx was positively correlated with the NIHSS score improvement at 7 days post-EVT (r =0.299, P =0.031), 90-day mRS score (r =0.382, P =0.005), pre-EVT infarct volume (r =0.561, P <0.001), and infarct volume growth at 48 hours post-EVT (r =0.286, P =0.040). Very low frequency phase shift was negatively correlated with pre-EVT infarct volume (r =-0.282, P =0.043) and 90-day mRS score (r =-0.276, P =0.048). Multivariate regression analysis showed that Mx was independently associated with 90-day poor prognosis (OR 132.69, 95%CI 5.71-3081.96, P =0.002). Conclusions For acute anterior circulation cerebral infarction patients who underwent EVT, good CA function early after EVT was associated with good prognosis. Compared with phase shift and gain, Mx has a stronger correlation with clinical outcome.

Key words: Cerebral autoregulation; Acute ischemic stroke; Endovascular treatment;Transfer function; Mean flow velocity index

张哲，濮月华，于蕾，段婉莹，米东华，刘丽萍. 急性前循环缺血性卒中血管内治疗术后早期脑血流自动调节功能与预后关系研究[J]. 中国卒中杂志, 2020, 15(12): 1299-1305.

ZHANG Zhe, PU Yue-Hua, YU Lei, DUAN Wan-Ying, MI Dong-Hua,LIU Li-Ping. The Association of Cerebral Autoregulation Function after Endovascular Treatment with Clinical Outcome in Acute Anterior Circulation Ischemic Stroke[J]. Chinese Journal of Stroke, 2020, 15(12): 1299-1305.

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