急性颅内动脉粥样硬化性大血管闭塞患者机械取栓术后早期预后预测指标筛选

Screening and Analysis of Early Prognostic Predictive Indicators in Patients with Acute Intracranial Atherosclerotic Large Vessel Occlusion Thrombectomy

摘要: 目的：针对颅内动脉粥样硬化(ICAS)所致急性前后循环大血管闭塞(LVO)机械取栓术后预后异质性大、临床缺乏简易预判指标的痛点，筛选可早期预测术后90天短期预后的核心指标。方法：回顾性分析2019年12月至2025年12月鄂尔多斯市中心医院收治的109例ICAS所致急性大血管闭塞并行机械取栓治疗患者的临床资料。依据术后90天改良Rankin量表(mRS)评分将患者分为预后良好组(mRS 0~2分，28例)与预后不良组(mRS 3~6分，81例)。比较两组基线临床资料、治疗前后神经功能缺损评分(NIHSS)及早期疗效差异，立足“入院基线–术后早期恢复–远期预后”递进逻辑，将单因素分析中P < 0.2的指标纳入多因素Logistic回归分析，筛选独立预后预测因子。结果：单因素分析显示，预后不良组入院时NIHSS评分、术后7 ± 3天美国国立卫生研究院卒中量表(NIHSS)评分显著高于预后良好组，NIHSS下降≥4分比例显著低于预后良好组，差异均有统计学意义(P < 0.05)；两组年龄、性别、高血压/糖尿病/高脂血症病史、吸烟/饮酒史、责任血管部位及血管再通成功率比较，差异均无统计学意义(P > 0.05)。多因素Logistic回归分析显示，仅术后7 ± 3天NIHSS评分升高是ICAS所致急性大血管闭塞取栓患者术后90天预后不良的独立预测因子(P < 0.001)，入院NIHSS评分、发病至穿刺时间及高血压病史与预后无独立关联(均P > 0.05)。结论：术后7 ± 3天NIHSS评分可作为ICAS-LVO患者机械取栓术后90天预后的简易早期预测指标，临床可通过评估该指标快速识别高风险患者，制定个体化干预方案，有效改善患者短期预后。

Abstract: Objective: To address the pain points of large prognostic heterogeneity and lack of simple clinical prognostic indicators after mechanical thrombectomy for acute anterior and posterior circulation large vessel occlusion (LVO) caused by intracranial atherosclerosis (ICAS), screen core indicators that can early predict short-term prognosis 90 days after surgery to provide objective basis for rapid clinical risk stratification and individualized intervention. Methods: The clinical data of 109 patients with acute large vessel occlusion caused by ICAS and treated with mechanical thrombectomy who were admitted to Ordos Central Hospital from December 2019 to December 2025 were retrospectively analyzed. According to the modified Rankin Scale (mRS) score 90 days after surgery, the patients were divided into a good prognosis group (mRS 0 to 2 points, 28 cases) and a poor prognosis group (mRS 3 to 6 points, 81 cases). The baseline clinical data, neurological deficit score (NIHSS) before and after treatment, and early efficacy differences between the two groups were compared. Based on the progressive logic of “admission baseline-early postoperative recovery-long-term prognosis”, indicators with P < 0.2 in the single-factor analysis were included in multi-factor logistic regression analysis to screen independent prognostic predictors. Results: Univariate analysis showed that the NIHSS score on admission and NIHSS score 7 ± 3 days after surgery in the poor prognosis group were significantly higher than those in the good prognosis group, and the proportion of NIHSS decreases of ≥4 points was significantly lower than that in the good prognosis group. The differences were statistically significant (all P < 0.05). There were no statistically significant differences between the two groups in terms of age, gender, history of hypertension/diabetes/hyperlipidemia, smoking/drinking history, responsible vessel location, and vascular recanalization success rate (all P > 0.05). Multivariate logistic regression analysis showed that only an increase in NIHSS score 7 ± 3 days after surgery was an independent predictor of poor prognosis in patients with acute large vessel occlusion thrombectomy due to ICAS at 90 days after surgery (P < 0.001). Admission NIHSS score, time from onset to puncture, and history of hypertension were not independently associated with prognosis (all P > 0.05). Conclusion: The NIHSS score at 7 ± 3 days after surgery can be used as a simple early predictor of the 90-day prognosis of patients with ICAS-LVO after mechanical thrombectomy. Clinical assessment of this index can quickly identify high-risk patients, develop individualized intervention plans, and effectively improve the short-term prognosis of patients.