中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (35): 7544-7551.doi: 10.12307/2025.955

• 组织构建实验造模 experimental modeling in tissue construction • 上一篇    下一篇

超声心动图参数与急性缺血性脑卒中发病3个月时残疾的相关性

杨  博，潘新芳，常留辉，倪  勇   

  1. 苏州大学附属第二医院麻醉科，江苏省苏州市  215004


  • 收稿日期:2024-10-22 接受日期:2024-12-23 出版日期:2025-12-18 发布日期:2025-04-30
  • 通讯作者: 倪勇，博士，副主任医师，苏州大学附属第二医院麻醉科，江苏省苏州市 215004
  • 作者简介:杨博，女，1987年生，江苏省苏州市人，汉族，2015年苏州大学毕业，博士，主治医师，主要从事脑缺血损伤保护及机制方面的研究。
  • 基金资助:
    国家自然科学基金项目(81601147)，项目负责人：杨博；苏州市卫生青年骨干人才“全国导师制”培训项目(Qngg2024006)，项目负责人：杨博；苏州市应用基础研究(医疗卫生)科技创新青年项目(SYW2024082)，项目负责人：杨博

Correlation of echocardiographic parameters with disability at 3 months after acute ischemic stroke

Yang Bo, Pan Xinfang, Chang Liuhui, Ni Yong   

  1. Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
  • Received:2024-10-22 Accepted:2024-12-23 Online:2025-12-18 Published:2025-04-30
  • Contact: Ni Yong, MD, Associate chief physician, Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
  • About author:Yang Bo, MD, Attending physician, Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
  • Supported by:
    National Natural Science Foundation of China, No. 81601147 (to YB); Suzhou Heath Young Key Talents "National Tutorial System" Training Project, No. Qngg2024006 (to YB); Suzhou Applied Basic Research (Healthcare) Science and Technology Innovation Youth Project, No. SYW2024082 (to YB)

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摘要：


文题释义：
三维超声斑点追踪技术：是结合二维超声斑点追踪技术及三维超声心动图的一种新技术，在三维空间基础上实现对心肌真实运动的追踪，主要是通过观察心肌内回声斑点的运动轨迹计算出心肌形变及运动数据，对整体和局部心肌功能进行定量评估，在临床诊疗中具有重要指导价值。
急性缺血性脑卒中发病3个月时残疾评估：随访急性缺血性脑卒中患者发病3个月时的改良Rankin量表(mRs)评分，mRS≤1分为无残疾，1分< mRS≤5分为残疾。

背景：经胸超声心动图和斑点追踪超声心动图参数与脑卒中的发生和预后密切相关，然而，关于经胸超声心动图与三维斑点追踪超声心动图参数对急性缺血性脑卒中患者发病后功能残疾的影响尚不清楚。
目的：探讨经胸超声心动图与三维斑点追踪超声心动图参数与急性缺血性脑卒中患者发病3个月时功能残疾的相关性。
方法：前瞻性纳入2020年12月至2022年9月在苏州大学附属第二医院神经内科就诊的299例急性缺血性脑卒中患者，根据发病3个月时改良Rankin量表评分分为无残疾组(改良Rankin量表评分≤1，n=207)和残疾组(1 < 改良Rankin量表评分≤5，n=92)，比较两组患者的基线资料、经胸超声心动图与三维斑点追踪超声心动图参数差异，采用多因素二元Logistic回归分析患者残疾的独立危险因素。将与预后不良相关的变量组合建立模型，采用受试者工作曲线评估模型对预后不良的预测效能。根据左室射血分数与患者发病后功能残疾的受试者工作曲线获得最佳界值，将患者分为高左室射血分数组和低左室射血分数组，采用卡方检验比较两组间预后不良率。
结果与结论：①与无残疾组相比，残疾组患者左室射血分数更低(P=0.011)，两组间入院美国国立卫生研究院脑卒中量表(NIHSS)评分、急性脑卒中Org10172治疗试验(TOAST)分型、牛津郡社区脑卒中计划(OCSP)分型存在显著差异(P < 0.05)；多因素Logistic回归分析显示，左室射血分数、入院NIHSS评分、OCSP分型与脑卒中发病3个月时残疾独立相关(P < 0.05)；②将入院NIHSS评分、OCSP分型纳入模型1，模型1加入左室射血分数为模型2，将所有单因素显著差异变量纳入模型3，受试者工作特征曲线分析显示三者预测脑卒中发病3个月时残疾的曲线下面积分别为0.769，0.806，0.824；③根据左室射血分数与发病3个月时残疾的受试者工作特征曲线得到左室射血分数的最佳切点为60.25%，将患者分为低左室射血分数组(左室射血分数≤60.25%)和高左室射血分数组(左室射血分数> 60.25%)，低左室射血分数组患者发病3个月时残疾率显著高于高左室射血分数组(44% vs. 26%，P=0.002)。结果表明：左室射血分数降低对缺血性脑卒中发病3个月功能残疾评估发挥重要作用，临床在评估缺血性脑卒中预后时可将左室射血分数纳入常规评估流程。
https://orcid.org/0009-0009-1238-4359(杨博)

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

关键词: 急性缺血性脑卒中, 经胸超声心动图, 三维斑点追踪超声心动图, 预后, 残疾, 左室射血分数, 改良Rankin量表, 受试者工作曲线, 工程化组织构建

Abstract: BACKGROUND: Transthoracic echocardiography and speckle tracking echocardiography parameters are closely related to stroke occurrence and prognosis. However, the role of transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters in predicting functional disability following acute ischemic stroke remains unclear.
OBJECTIVE: To explore the relationship between transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters and functional disability at 3 months post-stroke in patients with acute ischemic stroke.
METHODS: A total of 299 patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Soochow University between December 2020 and September 2022 were prospectively enrolled. Patients were divided into no disability (n=207) and disability (n=92) groups based on modified Rankin Scale (mRS) scores (≤ 1 as no disability; 1 < mRS score ≤ 5 as disability) at 3 months. Baseline characteristics and transthoracic echocardiography and three-dimensional speckle tracking echocardiography parameters were compared between groups. Independent risk factors for disability were identified using multivariate logistic regression. Predictive models were developed by incorporating variables associated with poor prognosis, and their performance was assessed using the receiver operating characteristic curve analysis. The optimal cutoff value for left ventricular ejection fraction was determined from the receiver operating characteristic curve, and patients were stratified into high and low left ventricular ejection fraction groups. Chi-square test was used to compare prognosis rate between two groups.
RESULTS AND CONCLUSION: (1) The disability group had significantly lower left ventricular ejection fraction compared with the no disability group (P=0.011). Significant differences in the National Institute of Health Stroke Scale scores, Trial of ORG 10172 in Acute Stroke Treatment, and Oxfordshire Community Stroke Project classifications were observed (P < 0.05). Multivariate logistic regression showed that left ventricular ejection fraction, National Institute of Health Stroke Scale scores, and Oxfordshire Community Stroke Project classification were independent predictors of 3-month disability (P < 0.05). (2) The National Institute of Health Stroke Scale scores and Oxfordshire Community Stroke Project classification at admission were included in model 1, which added the left ventricular ejection fraction as model 2, and all univariate significant difference variables were included in model 3. Receiver operating characteristic analysis showed the area under the curve values of 0.769, 0.806, and 0.824 for the models used to predict the 3-month disability rate. (3) The optimal cutoff for left ventricular ejection fraction from the receiver operating characteristic curve was 60.25%, classifying patients into low left ventricular ejection fraction (≤ 60.25%) and high left ventricular ejection fraction (> 60.25%) groups. The 3-month disability rate was higher in the low left ventricular ejection fraction group than in the high left ventricular ejection fraction group (44% vs. 26%, P=0.002). These findings highlight that reduced left ventricular ejection fraction plays an important role in the assessment of functional disability 3 months after acute ischemic stroke. Left ventricular ejection fraction can be incorporated into routine prognostic assessments when clinically evaluating the prognosis of ischemic stroke.

Key words: acute ischemic stroke, transthoracic echocardiography, three-dimensional speckle tracking echocardiography, prognosis, disability, left ventricular ejection fraction, modified Rankin Scale, receiver operating characteristic curve, engineered tissue construction

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