【作者】 刘勇；

【导师】 李光勤；

【作者基本信息】 重庆医科大学 ， 神经病学， 2020， 硕士

【摘要】 背景:急性缺血性脑卒中治疗核心是开通闭塞血管、血流复流、减少核心梗死体积;自2015年MR CLEAN、ESCAPE、EXTEND-IA、SWIFT PRIME、REVASCAT五大研究均证实急性期血管内治疗疗效肯定。但临床预后的差异较大,部分患者恢复良好、部分患者残疾、部分患者死亡。目前研究发现血管内治疗方式、是否桥接治疗、脑侧支循环、NIHSS评分、ASPECTS评分、时间窗、出血性转化等因素与急性缺血性脑卒中血管内治疗预后相关。血栓病理与急性缺血性脑卒中行血管内治疗预后相关性暂无报道。目的:探讨血栓病理与急性缺血性脑卒中血管内治疗预后的相关性。方法:连续入选血管内治疗的急性缺血性脑卒中获得脑动脉血栓的患者58例,取出的血栓采用HE染色行病理检查;测定红细胞及纤维蛋白/血小板成分的比率,依据红细胞在血栓中的占比分为富含红细胞组(红细胞比率≥70%)、混合组(红细胞比率31-69%)、富含纤维蛋白/血小板组(红细胞比率≤30%)。认定良好预后为术后90天m RS评分0-2分、不良预后为m RS评分3-6分,分为良好预后组及不良预后组。分析血栓病理类型与血管内治疗预后的相关性。结果:富含红细胞组为18.96%(11/58)、混合组为63.79%(37/58)、富含纤维蛋白/血小板组17.24%(10/58),良好预后组为43.10%(25/58)、不良预后组为56.90%(33/58)。富含红细胞组红细胞比率在良好预后组与不良预后组之间无统计学差异(P=0.713),混合组红细胞比率在良好预后组与不良预后组之间无统计学差异(P=0.829),富含纤维蛋白/血小板组红细胞比率在良好预后组与不良预后组之间无统计学差异(P=0.748)。在良好预后组与不良预后组之间入院时ASPECTS评分(P=0.008)、股动脉穿刺到血管再通的时间(P=0.016)和阿替普酶桥接治疗(P=0.012)有统计学差异。结论:血栓病理与急性缺血性脑卒中血管内治疗预后无相关性。更多还原

【Abstract】 Backgroud: The key to the treatment of acute ischemic stroke is to open occluded blood vessels,restore cerebral blood flow,and reduce the core infarct area as soon as possible.Since 2015 MR CLEAN,ESCAPE,EXTEND-IA,SWIFT PRIME and REVASCAT,these five studies have confirmed the efficacy of acute endovascular therapy.The clinical prognosis of patients with acute ischemic stroke who underwent intravascular treatment of intracranial vascular occlusion is quite different.Some patients recovered well,some patients had disability,and some patients died.The current study found that endovascular therapy manner,bridging treatment,cerebral collateral circulation,NIHSS score,ASPECTS,time window,hemorrhagic transformation and other factors may be correlated with the prognosis of endovascular therapy of acute ischemic stroke.The correlation between thrombopathology and prognosis of endovascular therapy in acute ischemic stroke has not been reported.Objective: To investigate the correlation between thrombosis pathology and prognosis of endovascular therapy for acute ischemic stroke.Methods: 58 consecutive patients with acute ischemic stroke who had acquired cerebral artery thrombosis were enrolled in this study.The thrombus was examined by HE staining.The ratio of erythrocyte and fibrin/platelet components was determined and divided into erythrocyte-rich group(erythrocyte ratio≥70%),mixed group(erythrocyte ratio31-69%)and fibrin/platelet-rich group(erythrocyte ratio≤30%).The good prognosis was defined as 0-2 m RS score at 90 days after operation and 3-6m RS score at adverse prognosis.The patients were divided into good prognosis group and bad prognosis group to analyze the correlation between the pathological type of thrombus.Results: Erythrocyte-rich group was 18.96%(11/58),mixed group was63.79%(37/58),fibrin/platelet group was 17.24%(10/58),the good prognosis was 43.10%(25/58),the bad prognosis was 56.90%(33/58).Erythrocyte ratio of erythrocyte-rich group between good prognosis group and bad prognosis group no statistical difference(P=0.713),the ratio of mixed group between good prognosis group and bad prognosis group no statistical difference(P=0.829),the ratio of fibrin/platelet group between good prognosis group and bad prognosis group no statistical difference(P=0.748).There were significant differences in ASPECTS score at admission(P=0.008),time from femoral artery puncture to recanalization(P=0.016)and alteplase bridging(P=0.012)between good prognosis group and bad prognosis group.Conclusion:There was no correlation between thrombosis pathology and prognosis of endovascular therapy for acute ischemic stroke.更多还原