急性前循环大血管闭塞卒中取栓术后预后不良影响因素及预测模型构建

doi:10.3877/cma.j.issn.2095-5782.2026.03.010

中华介入放射学电子杂志 ›› 2026, Vol. 14 ›› Issue (03) : 292 -298. doi: 10.3877/cma.j.issn.2095-5782.2026.03.010

论著

急性前循环大血管闭塞卒中取栓术后预后不良影响因素及预测模型构建

张菁菁¹, 朱发勇², 刘亚¹^,^†(

), 潘晓虎¹, 施学松¹, 杨明刚¹, 谢春明³, 赵国锋⁴

¹　211700　江苏盱眙，南京医科大学康达学院附属盱眙医院（江苏省盱眙县人民医院）神经内科
²　223834　江苏宿迁，江苏省人民医院宿迁医院神经内科
³　210029　江苏南京，东南大学附属中大医院神经内科
⁴　210029　江苏南京，东南大学附属中大医院介入放射科

收稿日期:2025-11-26 出版日期:2026-08-25
通信作者: 刘亚
基金资助:
南京医科大学康达学院科研发展基金(KD2023KYJJ183); 国家卫生健康委能力建设和继续教育中心课题(GWJJMB202510021122)

Factors Influencing Poor Prognosis After Endovascular Thrombectomy for Acute Ischemic Stroke of Anterior Circulation Large Vessel Occlusion and Construction of a Risk Prediction Model

Jingjing Zhang¹, Fayong Zhu², Ya Liu¹^,^†(), Xiaohu Pan¹, Xuesong Shi¹, Minggang Yang¹, Chunming Xie³, Guofeng Zhao⁴

¹ Department of neurology, XuYi Hospital Affiliated to Kangda College of Nanjing Medical University, Jiangsu Xuyi 211700
² Department of neurology, Suqian Hospital of Jiangsu Provincial People's Hospital, Jiangsu Suqian 223834, China
³ Department of neurology, ZhongDa Hospital Affiliated with Southeast University, Jiangsu Nanjing 210029, China
⁴ Department of Interventional Radiology, ZhongDa Hospital Affiliated with Southeast University, Jiangsu Nanjing 210029, China

Received:2025-11-26 Published:2026-08-25
Corresponding author: Ya Liu

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引用本文：

张菁菁, 朱发勇, 刘亚, 潘晓虎, 施学松, 杨明刚, 谢春明, 赵国锋. 急性前循环大血管闭塞卒中取栓术后预后不良影响因素及预测模型构建[J/OL]. 中华介入放射学电子杂志, 2026, 14(03): 292-298.

Jingjing Zhang, Fayong Zhu, Ya Liu, Xiaohu Pan, Xuesong Shi, Minggang Yang, Chunming Xie, Guofeng Zhao. Factors Influencing Poor Prognosis After Endovascular Thrombectomy for Acute Ischemic Stroke of Anterior Circulation Large Vessel Occlusion and Construction of a Risk Prediction Model[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 292-298.

目的

探讨前循环卒中机械取栓术(mechanical thrombectomy, MT)预后不良的影响因素，并构建预测模型。

方法

回顾性分析2020年1月至2024年12月江苏省人民医院宿迁医院、东南大学附属中大医院、南京医科大学康达学院附属盱眙人民医院行MT治疗的前循环急性大血管闭塞性卒中(acute large vessel occlusive stroke, ALVOS)患者的临床资料，根据术后90 d的预后情况分为预后良好组和不良预后组。分析基线资料、手术情况及围手术期并发症等，构建预测模型并验证其效能。

结果

共入组528例患者，再通成功496例。Logistic回归分析显示：年龄、就诊时间、美国国立卫生研究院卒中量表评分、取栓次数、再通成功、症状性颅内出血、术后24小时D-二聚体水平是预后不良的独立影响因素(P<0.05)。根据以上因素构建预测模型，校准曲线、决策曲线显示模型具有较好的准确度和临床效能。

结论

前循环ALVOS，根据年龄、就诊时间、D-二聚体、基线NIHSS评分、取栓次数、再通成功、症状性颅内出血构建的模型对不良预后的预测效能较好。

关键词: 急性大血管闭塞性卒中, 预后不良, 预测模型

Objective

To explore the influencing factors of poor prognosis after mechanical thrombectomy for anterior circulation stroke and to construct prediction model.

Methods

Patients with anterior circulation ALVOS who underwent mechanical thrombectomy from January 2020 to December 2024 were divided into good prognosis group and poor prognosis group based on the 90-day postoperative prognosis. The baseline data, surgical conditions, and perioperative complications were analyzed. A clinical prediction model was constructed and its accuracy and efficacy were verified.

Results

A total of 528 patients were enrolled. Logistic regression analysis indicated that age, time of consultation, D-dimer, NIHSS score, number of thrombectomy, symptomatic intracranial hemorrhage, and successful reperfusion were independent influencing factors for poor prognosis (P< 0.05). Based on the above factors, a prediction model was constructed, and the calibration curve and decision curve showed that the model had good efficacy.

Conclusion

The model constructed for anterior circulation ALVOS based on age, time of consultation, D-dimer, baseline NIHSS score, number of thrombectomy, successful reperfusion, and symptomatic intracranial hemorrhage has good predictive efficacy for poor prognosis.

Key words: Acute large vessel occlusive stroke, Poor prognosis, Prediction model

表1 预后良好组与不良预后组基线资料比较

项目	总计（n=528）	预后良好组（n=226）	预后不良组（n=302）	统计值	P值
男性[例(%)]	309(58.52)	142(62.83)	167(55.30)	χ²=3.023	0.082
女性[例(%)]	219(41.48)	84(37.17)	135(44.70)	χ²=3.023	0.082
年龄（岁, $x ¯$ ±s）	69.26±0.70	68.37±0.52	65.42±0.85	t=6.498	0.011
既往病史[例(%)]
高血压	359(67.42)	144(63.70)	215(71.19)	χ²=3.319	0.068
糖尿病	138(26.52)	49(21.68)	88(29.10)	χ²=3.742	0.053
高脂血症	146(27.65)	61(26.99)	85(28.15)	χ²=0.086	0.769
心房颤动	238(46.97)	94(41.59)	144(47.70)	χ²=2.879	0.09
冠心病	96(17.05)	35(15.50)	61(20.20)	χ²=1.929	0.165
吸烟史	119(22.54)	53(23.45)	66(21.85)	χ²=0.189	0.664
卒中史	128(24.24)	53(23.45)	75(24.83)	χ²=0.135	0.714
发病到就诊时间[分, M(Q₁，Q₃)]	210(120, 360)	180(93.75, 300)	279.5(150, 420)	Z=-3.329	<0.001
静脉溶栓[例(%)]	132(25.00)	67(29.65)	65(21.52)	χ²=4.549	0.033
BMI[kg/m², M(Q₁，Q₃)]	26.96(19.89, 29.05)	28.56(26.98, 30.25)	27.72(22.03, 29.05)	Z=-0.027	0.978
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.63(0.24, 1.25)	0.50(0.22, 0.93)	0.77(0.24, 1.57)	Z=-4.643	<0.001
基线NIHSS评分[分, M(Q₁，Q₃)]	16(11, 20)	13(9, 17.25)	18(13, 22)	Z=-7.282	<0.001
卒中病因[例(%)]				χ²=2.184	0.336
大动脉粥样硬化型	243(46.02)	108(47.79)	135(44.70)
心源性栓塞型	258(48.86)	110(48.67)	148(49.01)
其他	27(5.11)	8(3.54)	19(6.29)

表1 预后良好组与不良预后组基线资料比较

项目	总计（n=528）	预后良好组（n=226）	预后不良组（n=302）	统计值	P值
男性[例(%)]	309(58.52)	142(62.83)	167(55.30)	χ²=3.023	0.082
女性[例(%)]	219(41.48)	84(37.17)	135(44.70)	χ²=3.023	0.082
年龄（岁, $x ¯$ ±s）	69.26±0.70	68.37±0.52	65.42±0.85	t=6.498	0.011
既往病史[例(%)]
高血压	359(67.42)	144(63.70)	215(71.19)	χ²=3.319	0.068
糖尿病	138(26.52)	49(21.68)	88(29.10)	χ²=3.742	0.053
高脂血症	146(27.65)	61(26.99)	85(28.15)	χ²=0.086	0.769
心房颤动	238(46.97)	94(41.59)	144(47.70)	χ²=2.879	0.09
冠心病	96(17.05)	35(15.50)	61(20.20)	χ²=1.929	0.165
吸烟史	119(22.54)	53(23.45)	66(21.85)	χ²=0.189	0.664
卒中史	128(24.24)	53(23.45)	75(24.83)	χ²=0.135	0.714
发病到就诊时间[分, M(Q₁，Q₃)]	210(120, 360)	180(93.75, 300)	279.5(150, 420)	Z=-3.329	<0.001
静脉溶栓[例(%)]	132(25.00)	67(29.65)	65(21.52)	χ²=4.549	0.033
BMI[kg/m², M(Q₁，Q₃)]	26.96(19.89, 29.05)	28.56(26.98, 30.25)	27.72(22.03, 29.05)	Z=-0.027	0.978
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.63(0.24, 1.25)	0.50(0.22, 0.93)	0.77(0.24, 1.57)	Z=-4.643	<0.001
基线NIHSS评分[分, M(Q₁，Q₃)]	16(11, 20)	13(9, 17.25)	18(13, 22)	Z=-7.282	<0.001
卒中病因[例(%)]				χ²=2.184	0.336
大动脉粥样硬化型	243(46.02)	108(47.79)	135(44.70)
心源性栓塞型	258(48.86)	110(48.67)	148(49.01)
其他	27(5.11)	8(3.54)	19(6.29)

表2 预后良好组与不良预后组手术参数比较

手术参数	预后良好组(n=226)	预后不良组(n=302)	统计值	P值
股动脉穿刺到再通时间[分, M(Q₁，Q₃)]	64.0(49.0, 82.0)	65.0(50.0, 92.0)	Z=-2.112	0.035
手术时间[分, M(Q₁，Q₃)]	101.5(75.0, 130.0)	110.0(80.0, 155.0)	Z=-2.279	0.023
MT次数[次, M(Q₁，Q₃)]	1(1, 2)	1(1, 2)	Z=-5.837	<0.001
保护伞装置使用[例(%)]	26(11.5)	29(9.6)	χ²=0.501	0.479
手术方式[例(%)]			χ²=0.624	0.429
MT	156(69.03)	218(72.19)
MT+血管成形	70(30.97)	84(27.81)
mTICI≥2b[例(%)]	224(99.12)	272(90.07)	χ²=18.591	<0.001

表2 预后良好组与不良预后组手术参数比较

手术参数	预后良好组(n=226)	预后不良组(n=302)	统计值	P值
股动脉穿刺到再通时间[分, M(Q₁，Q₃)]	64.0(49.0, 82.0)	65.0(50.0, 92.0)	Z=-2.112	0.035
手术时间[分, M(Q₁，Q₃)]	101.5(75.0, 130.0)	110.0(80.0, 155.0)	Z=-2.279	0.023
MT次数[次, M(Q₁，Q₃)]	1(1, 2)	1(1, 2)	Z=-5.837	<0.001
保护伞装置使用[例(%)]	26(11.5)	29(9.6)	χ²=0.501	0.479
手术方式[例(%)]			χ²=0.624	0.429
MT	156(69.03)	218(72.19)
MT+血管成形	70(30.97)	84(27.81)
mTICI≥2b[例(%)]	224(99.12)	272(90.07)	χ²=18.591	<0.001

表3 预后良好组与不良预后组患者围手术期并发症的比较

并发症及预后参数	预后良好组(n=226)	预后不良组(n=302)	χ²值	P值
症状性颅内出血[例(%)]	5 (2.21)	111(36.75)	89.971	<0.001
术中动脉穿孔[例(%)]	3(1.33)	5(1.66)	1.000	0.528
肺部感染[例(%)]	65(28.76)	105(34.77)	2.137	0.144

表3 预后良好组与不良预后组患者围手术期并发症的比较

并发症及预后参数	预后良好组(n=226)	预后不良组(n=302)	χ²值	P值
症状性颅内出血[例(%)]	5 (2.21)	111(36.75)	89.971	<0.001
术中动脉穿孔[例(%)]	3(1.33)	5(1.66)	1.000	0.528
肺部感染[例(%)]	65(28.76)	105(34.77)	2.137	0.144

表4 前循环ALVOS患者MT预后不良的二元Logistic回归分析

项目	B值	Wald卡方值	OR值（95% CI）	P值
常量	-3.063	8.200	OR=0.047	0.004
男性[例(%)]	-0.018	0.005	0.982(0.608~1.588)	0.942
年龄[岁, $x ¯$ ±s]	0.033	9.948	1.034(1.013~1.055)	0.002
高血压[例(%)]	-0.230	0.809	0.794(0.481~1.312)	0.368
糖尿病[例(%)]	-0.429	2.502	0.651(0.382~1.108)	0.114
心房颤动[例(%)]	0.006	0.109	1.093(0.644~1.856)	0.741
发病到就诊时间[分, M(Q₁，Q₃)]	0.002	12.736	1.002(1.001~1.003)	<0.001
静脉溶栓[例(%)]	0.006	0.001	1.006(0.587~1.722)	0.984
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.808	23.030	2.243(1.613~3.120)	<0.001
入院NIHSS评分[分, M(Q₁，Q₃)]	0.108	29.363	1.114(1.071~1.158)	<0.001
穿刺到再通时间[分, M(Q₁，Q₃)]	0.001	0.042	1.001(0.991~1.011)	0.838
手术时间[分, M(Q₁，Q₃)]	0.002	0.465	1.002(0.996~1.009)	0.495
MT次数[次, M(Q₁，Q₃)]	0.630	14.276	1.877(1.354~2.603)	<0.001
mTICI≥2b[例(%)]	1.737	4.709	5.681(1.183~27.276)	0.030
症状性颅内出血[例(%)]	-3.316	45.238	0.036(0.014~0.095)	<0.001

表4 前循环ALVOS患者MT预后不良的二元Logistic回归分析

项目	B值	Wald卡方值	OR值（95% CI）	P值
常量	-3.063	8.200	OR=0.047	0.004
男性[例(%)]	-0.018	0.005	0.982(0.608~1.588)	0.942
年龄[岁, $x ¯$ ±s]	0.033	9.948	1.034(1.013~1.055)	0.002
高血压[例(%)]	-0.230	0.809	0.794(0.481~1.312)	0.368
糖尿病[例(%)]	-0.429	2.502	0.651(0.382~1.108)	0.114
心房颤动[例(%)]	0.006	0.109	1.093(0.644~1.856)	0.741
发病到就诊时间[分, M(Q₁，Q₃)]	0.002	12.736	1.002(1.001~1.003)	<0.001
静脉溶栓[例(%)]	0.006	0.001	1.006(0.587~1.722)	0.984
D-二聚体水平[mg/L, M(Q₁，Q₃)]	0.808	23.030	2.243(1.613~3.120)	<0.001
入院NIHSS评分[分, M(Q₁，Q₃)]	0.108	29.363	1.114(1.071~1.158)	<0.001
穿刺到再通时间[分, M(Q₁，Q₃)]	0.001	0.042	1.001(0.991~1.011)	0.838
手术时间[分, M(Q₁，Q₃)]	0.002	0.465	1.002(0.996~1.009)	0.495
MT次数[次, M(Q₁，Q₃)]	0.630	14.276	1.877(1.354~2.603)	<0.001
mTICI≥2b[例(%)]	1.737	4.709	5.681(1.183~27.276)	0.030
症状性颅内出血[例(%)]	-3.316	45.238	0.036(0.014~0.095)	<0.001

图1 ROC曲线评价模型预测MT预后不良的准确性（曲线下面积=0.864） ROC曲线：受试者工作特征曲线；MT：机械取栓术；AUC：曲线下面积。

图2 前循环ALVOS患者MT预后不良风险预测模型校准曲线 ALVOS：急性大血管闭塞性卒中；MT：机械取栓术。

图3 前循环ALVOS患者MT治疗预后不良风险预测模型决策曲线 ALVOS：急性大血管闭塞性卒中；MT：机械取栓术。

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Factors Influencing Poor Prognosis After Endovascular Thrombectomy for Acute Ischemic Stroke of Anterior Circulation Large Vessel Occlusion and Construction of a Risk Prediction Model

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Factors Influencing Poor Prognosis After Endovascular Thrombectomy for Acute Ischemic Stroke of Anterior Circulation Large Vessel Occlusion and Construction of a Risk Prediction Model