Abstract: Objective  To investigate the association between cerebral autoregulation (CA) function and 90-day outcomes in patients with different subtypes of acute ischemic stroke (AIS) receiving intravenous thrombolysis.
Methods  This prospective cohort study included patients with AIS who received intravenous thrombolysis at the Stroke Center, Department of Neurology, the First Hospital of Jilin University between September 2016 and March 2022. Patients were classified according to TOAST criteria into large-artery atherosclerosis, small-artery occlusion, and undetermined etiology subtypes. CA function was assessed within 3 days and at 7-10 days after onset. CA parameters, including phase difference, gain, and coherence function, were calculated using transfer function analysis. Functional outcome was assessed using the mRS at (90±7) days after onset, with an mRS score of 0-2 defined as a favorable outcome, and a score of 3-6 defined as an unfavorable outcome.  Multivariable logistic regression analysis was used to evaluate the association between CA function and 90-day outcomes.
Results  A total of 202 patients were included, of whom 66 had large-artery atherosclerosis (32.7%), 114 had small-artery occlusion (56.4%), and 22 had undetermined etiology (10.9%). Among patients with large-artery atherosclerosis, phase differences on both the affected (P=0.004) and unaffected sides (P<0.001) within 3 days after onset were higher in the favorable outcome group than in the unfavorable outcome group. Multivariable logistic regression analysis showed that phase difference on the affected side within 3 days was independently associated with a 90-day unfavorable outcome (adjusted OR 0.918, 95%CI 0.844-0.999, adjusted P=0.046). Among patients with small-artery occlusion, bilateral phase differences within 3 days and at 7-10 days after onset were higher in the favorable outcome group than in the unfavorable outcome group (all P<0.05). After adjusting for relevant confounders, phase differences on the affected side (adjusted OR 0.967, 95%CI 0.941-0.993, adjusted P=0.015) and unaffected side (adjusted OR 0.966, 95%CI 0.940-0.992, adjusted P=0.011) within 3 days remained independently associated with a 90-day unfavorable outcome. In patients with undetermined etiology, no significant association was observed between CA parameters and a 90-day outcome.
Conclusions  Phase difference within 3 days after stroke onset was significantly associated with a 90-day functional outcome in AIS patients with large-artery atherosclerosis and small-artery occlusion receiving intravenous thrombolysis.

Key words: Acute ischemic stroke; Cerebral autoregulation; Trial of Org 10172 in acute stroke treatment classification; Intravenous thrombolysis

摘要： 目的 探讨脑血流自动调节（cerebral autoregulation，CA）功能与不同亚型的急性缺血性卒中静脉溶栓患者90 d预后的关系。
方法 本研究为前瞻性队列研究，纳入2016年9月—2022年3月于吉林大学第一医院神经内科卒中中心接受静脉溶栓治疗的急性缺血性卒中患者，并依据TOAST分型标准分为大动脉粥样硬化型、小动脉闭塞型和不明原因型。分别于发病3 d内及发病后7～10 d评估CA功能，通过传递函数分析计算相位差、增益、相干函数等CA参数。发病后（90±7）d采用mRS评估功能预后，mRS评分0～2分定义为良好预后，评分3～6分定义为不良预后。通过多因素logistic回归分析CA功能与患者90 d预后的相关性。
结果 本研究最终共纳入202例患者，其中大动脉粥样硬化型66例（32.7%），小动脉闭塞型114例（56.4%），不明原因型22例（10.9%）。大动脉粥样硬化型患者中，良好预后组发病3 d内患侧（P=0.004）及健侧相位差（P<0.001）均高于不良预后组；多因素logistic回归分析显示，发病3 d内患侧相位差与90 d不良预后独立相关（校正OR 0.918，95%CI 0.844～0.999，校正P=0.046）。小动脉闭塞型患者中，良好预后组发病3 d内及发病后7～10 d双侧相位差均高于不良预后组（均P<0.05）；校正相关混杂因素后，发病3 d内患侧相位差（校正OR 0.967，95%CI 0.941～0.993，校正P=0.015）和健侧相位差（校正OR 0.966，95%CI 0.940～0.992，校正P=0.011）均与90 d不良预后独立相关。不明原因型患者中，CA参数与90 d预后未见显著相关性。
结论 发病3 d内相位差与大动脉粥样硬化型及小动脉闭塞型急性缺血性卒中静脉溶栓患者90 d功能预后显著相关。

关键词: 急性缺血性卒中; 脑血流自动调节; 急性卒中治疗Org 10172试验分型; 静脉溶栓