广西医学

目的探讨系统免疫炎症指数（SII）联合血管事件总体健康风险（THRIVE）评分与急性脑梗死（ACI）患者机械取栓（MT）术后发生颅内出血转化（HT）及预后的关系。方法回顾性分析接受MT治疗的199例ACI患者的临床资料，根据患者术后24 h是否发生颅内HT分为发生HT组与未发生HT组。比较两组患者的SII、THRIVE评分，分析SII、THRIVE评分与ACI患者MT术后发生颅内HT的相关性。根据患者发病后90 d的改良Rankin量表（mRS）评分将其分为预后良好组与预后不良组，采用多因素Logistic回归模型分析ACI患者MT术后预后的影响因素，采用受试者工作特征（ROC）曲线分析SII、THRIVE评分预测ACI患者MT术后预后不良的价值。结果 199例ACI患者中，有77例MT术后发生颅内HT，发生率为38.69%。发生HT组患者的术前SII、术前THRIVE评分高于未发生HT组，术前SII、术前THRIVE评分与ACI患者MT术后发生颅内HT呈正相关（P<0.05）。199例ACI患者中，预后不良患者有52例，发生率为26.13%。预后不良组患者的术前SII、术前THRIVE评分、术前美国国立卫生研究院卒中量表（NIHSS）评分、术后首次SII、住院期间发生脓毒性休克比例、出院时mRS评分、术后发生颅内HT的比例高于预后良好组（P<0.05）。多因素Logistic回归分析结果显示，术前SII、术前THRIVE评分、术前NIHSS评分、术后首次SII、出院时mRS评分、住院期间发生脓毒性休克、术后发生颅内HT是ACI患者MT术后预后不良的影响因素（P<0.05）。ROC曲线分析结果显示，术前SII、术前THRIVE评分及术后首次SII联合预测ACI患者MT术后预后不良的价值较高（曲线下面积为0.899）。结论术前SII、术前THRIVE评分与ACI患者MT术后发生颅内HT呈正相关，且术前SII、术前THRIVE评分及术后首次SII联合预测ACI患者MT术后预后不良的价值较高。

Objective To investigate the relation of systemic immune⁃inflammation index (SII) combined with total health risks in vascular events (THRIVE) score with intracranial hemorrhagic transformation (HT) and prognosis in patients with acute cerebral infarction (ACI) after mechanical thrombectomy (MT). Methods The clinical data of 199 ACI patients who received MT treatment were retrospectively analyzed. According to whether intracranial HT occurred within 24 hours after surgery, the patients were divided into HT occurrence group or non⁃HT occurrence group. The SII and THRIVE scores of the two groups were compared, and the correlation of SII and THRIVE score with intracranial HT after MT in ACI patients was analyzed. According to the modified Rankin Scale (mRS) score at 90 days after onset, the patients were assigned to the favorable prognosis group or the poor prognosis group. Multivariate Logistic regression model was used to analyze the influencing factors for prognosis after MT in ACI patients, and receiver operating characteristic (ROC) curve was adopted to analyze the value of SII and THRIVE score in predicting poor prognosis after MT in ACI patients. Results Among the 199 ACI patients, 77 cases developed intracranial HT after MT, with an incidence rate of 38.69%. The preoperative SII and preoperative THRIVE score in the HT occurrence group were higher than those in the non⁃HT occurrence group (P<0.05). Preoperative SII and preoperative THRIVE score positively correlated with intracranial HT after MT in ACI patients (P<0.05). Among the 199 ACI patients, 52 cases had poor prognosis, with an incidence rate of 26.13%. The preoperative SII, preoperative THRIVE score, preoperative National Institutes of Health Stroke Scale (NIHSS) score, first postoperative SII, proportion of septic shock during hospitalization, mRS score at discharge, and proportion of postoperative intracranial HT in the poor prognosis group were higher than those in the favorable prognosis group (P<0.05). Multivariate Logistic regression analysis results revealed that preoperative SII, preoperative THRIVE score, preoperative NIHSS score, first postoperative SII, mRS score at discharge, septic shock during hospitalization, and postoperative intracranial HT occurrence were the influencing factors for poor prognosis after MT in ACI patients (P<0.05). ROC curve analysis results indicated that preoperative SII, preoperative THRIVE score, and first postoperative SII for jointly predicting poor prognosis after MT in ACI patients (with area under the curve of 0.899) had a relatively high value. Conclusion Preoperative SII and preoperative THRIVE score positively correlate with intracranial HT after MT in ACI patients, and preoperative SII, preoperative THRIVE score, and first postoperative SII for jointly predicting poor prognosis after MT in ACI patients have a relatively high value.