南方医科大学学报

南方医科大学学报 ›› 2022, Vol. 42 ›› Issue (9): 1397-1402.doi: 10.12122/j.issn.1673-4254.2022.09.17

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营养状况是影响临床预后的重要因素：基于459例急性前循环大血管闭塞性卒中急诊取栓治疗患者的回顾性分析

孙 毅，纪亚晨，吴康飞，王 昊，郭亚鹏，许向军，尚贤金，杨 倩，黄显军，周志明   

  1. 皖南医学院第一附属医院（弋矶山医院）神经内科，安徽 芜湖 241001
  • 发布日期:2022-09-28

Association of nutritional status with clinical outcomes of stroke patients with acute anterior circulation large vessel occlusion after emergency endovascular treatment

SUN Yi, JI Yachen, WU Kangfei, WANG Hao, GUO Yapeng, XU Xiangjun, SHANG Xianjin, YANG Qian, HUANG Xianjun, ZHOU Zhiming   

  1. Department of Neurology, Yijishan Hosotial, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, China
  • Published:2022-09-28

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摘要： 目的 探讨营养状态对急性前循环大血管闭塞性卒中早期血管内治疗（EVT）患者90 d功能预后的影响。方法 回顾性分析2015年7月~2020年12月在皖南医学院第一附属医院（弋矶山医院）行EVT的前循环大血管闭塞患者，收集并记录患者的基线资料、实验室数据、手术资料及90 d预后。营养状态用预后营养指数（PNI）进行评估，即血清白蛋白（g/L）+5×总淋巴细胞计数（109/L）。采用单因素和多因素回归分析探究营养指标PNI与90 d功能预后的关系。结果 共纳入459例患者，平均年龄（68.29±11.21）岁，男性260例（56.6%），根据PNI分组：营养正常392例（85.4%）、中度营养不良44例（9.6%）和重度营养不良23例（5.0%）。单因素分析显示：预后良好组中无营养不良的比例高、年龄较小、糖尿病比例较低、基线血压较低、基线NIHSS评分较低、基线ASPECT评分较高、良好侧支循环及血管完全再通比例较高。多因素分析显示：除年龄、糖尿病、基线收缩压、血管成功再通、基线ASPECT评分、基线NIHSS评分及侧支循环外，PNI是EVT患者90 d预后的独立危险因素（中度比重度OR=0.245，95% CI：0.066~0.908，P=0.035；正常比重度OR=0.185，95% CI：0.059~0.581，P=0.004）。结论 营养状态是影响EVT治疗患者预后的重要因素之一。

关键词: 血管内治疗；营养状况；急性大血管闭塞性卒中；预后；预后营养指数

Abstract: Objective To explore the influence of nutritional status on 90-day functional outcomes of stroke patients with acute large vessel occlusion in the anterior circulation after endovascular treatment (EVT). Methods We retrospectively analyzed the baseline, laboratory, surgical and 90-day follow-up data of patients with stroke resulting from acute large vessel occlusion in the anterior circulation, who underwent emergency endovascular treatment in our hospital from July, 2015 to December, 2020. A favorable outcome was defined as a modified Rankin scale score ≤2 at 90 days. Univariate and multivariate regression analyses were performed to explore the relationship between nutritional status and 90-day functional outcomes of the patients. Results A total of 459 patients (mean age of 68.29±11.21 years, including 260 males) were enrolled in this study. According to their prognostic nutritional index (PNI), the patients were divided into normal nutrition group (392 cases, 85.4% ), moderate malnutrition group (44 cases, 9.6% ), and severe malnutrition group (23 cases, 5.0% ). Univariate analysis showed that the patients with good clinical outcomes had a lower proportion of malnutrition with a younger age, a lower rate of diabetes, lower baseline blood pressure, lower baseline NIHSS score, higher baseline ASPECT score, and higher rates of good collateral circulation and complete vascular recanalization. Multivariate analysis showed that in addition to age, diabetes, baseline systolic blood pressure, successful recanalization, baseline ASPECT score, baseline NIHSS score and collateral circulation, a greater PNI was a protective factor for a good 90-day outcome of patients after EVT (moderate vs severe: OR=0.245, 95% CI: 0.066- 0.908, P=0.035; normal vs severe: OR=0.185, 95% CI: 0.059- 0.581, P=0.004). Conclusion Nutritional status an important factor affecting the 90-day outcomes after EVT of stroke patients with acute large vessel occlusion in the anterior circulation.

Key words: endovascular treatment; nutritional status; acute large vessel occlusion stroke; clinical prognosis; prognostic nutritional index