南通大学学报(医学版)

目的：探讨心房颤动所致急性前循环大血管闭塞机械取栓治疗的不良预后因素。方法：回顾性分析2021年5月—2024年6月南通市第一人民医院收治的103例心房颤动所致急性前循环大血管闭塞行机械取栓治疗患者的临床资料。术后90 d采用改良Rankin量表(modified Rankin scale, mRS)评估预后，将患者分为预后良好组(mRS 0～2分)和预后不良组(mRS 3～6分)；采用单因素和多因素Logistic回归分析法判断影响患者预后的危险因素，并应用ROC曲线评价相关指标的预测效能。结果：多因素Logistic回归分析显示：基线NIHSS评分、术前核心梗死体积、术后发生症状性出血转化(symptomatic hemorrhage transformation, sHT)是患者预后不良的独立预测因子(均P<0.05)。ROC曲线分析显示基线NIHSS评分预测不良预后的AUC为0.768，敏感度82.1%，特异度73.6%；术前核心梗死体积的AUC为0.763，敏感度78.9%，特异度71.4%；术后发生sHT的AUC为0.638，敏感度33.3%，特异度92.9%。结论：基线NIHSS评分、术前核心梗死体积、术后发生sHT是心房颤动致急性前循环大血管闭塞机械取栓术后不良预后的独立预测因子。

Objective: To explore factors of poor prognosis in mechanical thrombectomy for acute anterior circulation large vessel occlusion due to atrial fibrillation. Methods: This was a retrospective review of 103 patients with acute anterior circulatory large vessel occlusion caused by atrial fibrillation treated with mechanical thrombectomy at the First People's Hospital of Nantong from May 2021 to June 2024. At 90 days post-procedure, the outcomes of all patients was assessed based on the modified Rankin scale(mRS), of which the points of 0-2 were divided into good prognosis group and the points of 3-6 were divided into poor prognosis group. The univariate and multivariate Logistic regression analysis were used to determine the risk factors affecting the prognosis of patients. And apply the ROC curve to evaluate the predictive performance of relevant indicators.Results: The multivariate Logistic regression analysis showed that baseline NIHSS score, preoperative core infarct volume,postoperative symptomatic hemorrhage transformation(sHT) are the risk factors of poor prognosis(all P<0.05). ROC curve analysis showed that the AUC for baseline NIHSS score in predicting poor prognosis was 0.768, with a sensitivity of 82.1% and specificity of 73.6%. The AUC for preoperative core infarct volume was 0.763, with a sensitivity of 78.9% and specificity of71.4%. The AUC for postoperative sHT was 0.638, with a sensitivity of 33.3% and specificity of 92.9%. Conclusion: Baseline NIHSS score, preoperative core infarct volume, and postoperative sHT are independent predictors of poor prognosis after mechanical thrombectomy for acute anterior circulation large vessel occlusion caused by atrial fibrillation.