动态脑血流自动调节功能检查对急性缺血性卒中血管内血栓切除术后完全再通患者不良预后的预测价值

doi:10.3969/j.issn.1673-5765.2025.03.015

摘要/Abstract

摘要： 目的探索急性缺血性卒中（acute ischemic stroke，AIS）患者接受血管内血栓切除术（endovascular thrombectomy，EVT）完全再通后的动态脑血流自动调节（dynamic cerebral autoregulation，dCA）功能变化情况，并探讨dCA与患者临床预后的关系。
方法本研究纳入2022年3—9月因大脑中动脉或颈内动脉闭塞导致的AIS患者，所有患者均行EVT。对照组为首都医科大学宣武医院行dCA检查的无神经系统疾病人群，根据年龄、性别进行1∶1匹配。通过传递函数分析获取EVT术后12 h和术后5 d dCA的超低频（very low frequency，VLF）及低频的相位差、增益、一致性以及两次检查VLF相位差的差值（Δ相位差）等参数。EVT后3个月采用mRS评估临床预后，mRS评分≤2分定义为预后良好，mRS评分3～6定义为预后不良。采用logistic回归分析影响临床结局的危险因素。
结果最终纳入接受EVT的AIS患者43例及健康对照者43名，AIS患者中预后良好组27例，预后不良组16例。与健康对照者相比，接受EVT的AIS患者术后12 h的患侧VLF相位差明显受损[（39.31±24.11）°vs.（65.26±19.87）°]。预后良好组术后5 d患侧VLF相位差较术后12 h明显好转[（54.95±21.78）°vs.（38.74±22.33）°，P=0.004]，但预后不良组术后5 d患侧VLF相位差较术后12 h未见恢复[（24.54±16.35）°vs.（40.27±27.60）°，P=0.063]。logistic回归分析结果显示，接受EVT的AIS患者患侧相位差与临床预后不良明显相关（校正后OR 0.911，95%CI 0.854～0.972，P=0.005）。Δ相位差（相位差5 d-相位差12 h）是接受EVT的AIS患者术后3个月临床预后不良的独立危险因素（校正后OR 1.061，95%CI 1.016～1.109，P=0.008）。ROC曲线分析显示，术后5 d VLF相位差为35°是预测AIS术后3个月预后良好的最佳界值（AUC 0.878，95%CI 0.756～1.000，P<0.001）。
结论接受EVT的AIS患者，术后dCA功能受损。第5天相位差、Δ相位差是临床预后的独立预测因素。dCA可能为接受EVT的AIS患者提供一种预测临床预后的新手段。

关键词: 头-颈血管成像; 神经病学; 卒中; 超声; 血管手术

Abstract: Objective To explore the changes in dynamic cerebral autoregulation (dCA) function after complete recanalization of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS), and to investigate the relationship between dCA and clinical prognosis of patients.
Methods This study included patients with AIS caused by the occlusion of the middle cerebral artery or internal carotid artery from March to September 2022, all of whom underwent EVT. The control group consisted of individuals without neurological diseases who underwent dCA examination at Xuanwu Hospital, Capital Medical University, and were matched 1∶1 based on age and gender. Through transfer function analysis, parameters such as the phase difference, gain, and consistency of very low frequency (VLF) and low frequency at 12 hours and 5 days after EVT, as well as the difference in VLF phase difference between the two examinations, were obtained. The mRS at 3 months after EVT was used to assess the clinical prognosis. The good prognosis group was defined with mRS score≤2 points and the poor prognosis group was defined with mRS score of 3-6 points. Logistic regression analysis was used to analyze the risk factors affecting clinical prognosis.
Results A total of 43 AIS patients who underwent EVT and 43 healthy controls were ultimately included, with 27 patients in the good prognosis group and 16 in the poor prognosis group. Compared with the healthy controls, the VLF phase difference on the affected side of AIS patients who underwent EVT was significantly impaired 12 hours after EVT [(39.31±24.11)° vs. (65.26±19.87)°]. The VLF phase difference on the affected side in the good prognosis group at 5 days after EVT was significantly improved compared to 12 hours after EVT [(54.95±21.78)° vs. (38.74±22.33)°, P=0.004], while the VLF phase difference on the affected side in the poor prognosis group did not recover at 5 days after EVT compared to 12 hours after EVT [(24.54±16.35)° vs. (40.27±27.60)°, P=0.063]. Logistic regression analysis showed that the phase difference on the affected side of AIS patients was significantly related to bad clinical prognosis (adjusted OR 0.911, 95%CI 0.854-0.972, P=0.005). The Δphase difference (phase difference5 days-phase difference12 hours) was an independent risk factor for the bad clinical prognosis at 3 months after surgery in AIS patients receiving EVT (adjusted OR 1.061, 95%CI 1.016-1.109, P=0.008). ROC curve analysis showed that VLF phase difference of 35° at 5 days after EVT was optimal cutoff value for predicting good prognosis at 3 months after AIS surgery (AUC 0.878, 95%CI 0.756-1.000, P<0.001).
Conclusions The dCA function was impaired in patients with AIS after EVT. The Δphase difference were independent predictors of the clinical prognosis. The dCA may provide a new means of predicting clinical prognosis for AIS patients treated with EVT.

Key words: Head-and-neck angiography; Neurology; Stroke; Ultrasound; Vascular surgery

中图分类号:

刘然, 王平平, 陈虹秀, 李娜, 周福波, 赵文博, 马青峰, 邢英琦. 动态脑血流自动调节功能检查对急性缺血性卒中血管内血栓切除术后完全再通患者不良预后的预测价值[J]. 中国卒中杂志, 2025, 20(3): 365-372.

LIU Ran, WANG Pingping, CHEN Hongxiu, LI Na, ZHOU Fubo, ZHAO Wenbo, MA Qingfeng, XING Yingqi. The Predictive Value of Dynamic Cerebral Autoregulation for Poor Prognosis in Acute Ischemic Stroke Patients with Complete Recanalization after Endovascular Thrombectomy[J]. Chinese Journal of Stroke, 2025, 20(3): 365-372.

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