{"title":"急性缺血性脑卒中患者接受血管内治疗后血脑屏障破坏与脑卒中相关肺炎之间的关系：一项回顾性队列研究。","authors":"Haojun Ma, Rui Chen, Nannan Han, Hanming Ge, Shilin Li, Yanfei Wang, Xudong Yan, Chengxue Du, Yanjun Gao, Gejuan Zhang, Mingze Chang","doi":"10.2147/CIA.S475887","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Stroke, particularly due to large vessel occlusion (LVO), is a major cause of mortality and disability globally. Endovascular therapy (ET) significantly improves outcomes for acute ischemic stroke (AIS) patients, but complications such as stroke-associated pneumonia (SAP) increase mortality and healthcare costs. This study investigates the association between blood-brain barrier (BBB) disruption and the increased risk of SAP and explores the relationship between BBB disruption and medium-term functional outcomes.</p><p><strong>Methods: </strong>The retrospective cohort study was performed on AIS patients enrolled between January 2019 to February 2023 who underwent ET. Patients were divided into two groups: BBB disruption and without BBB disruption. Multiple logistic regression model was conducted to measure the association between BBB disruption and SAP. Mediation analysis was used to estimate the potential mediation effects on the associations of BBB disruption with SAP. A restricted cubic spline (RCS) regression model was used to further outline the connection between the highest CT value of hyperattenuated lesions areas and the risk of SAP.</p><p><strong>Results: </strong>The study included 254 patients who underwent endovascular therapy, with 155 patients in the BBB disruption group (exposure) and 99 patients in the without BBB disruption group (control). Multiple logistic regression analysis revealed a significantly increased risk of SAP in patients with BBB disruption (OR = 2.337, 95% CI: 1.118-4.990, p = 0.025). Furthermore, mediation analysis suggested that this association may be partly due to malignant cerebral oedema and haemorrhagic transformation. The study found an inverse L-shaped dose-response relationship between the maximum CT values of BBB disruption areas and the incidence of SAP. SAP partially mediated the association between BBB disruption and 3-month poor functional outcome.</p><p><strong>Conclusion: </strong>BBB disruption are a potential risk factor for SAP. BBB disruption may affect short- and medium-term prognosis of patients after ET in part through SAP.</p>","PeriodicalId":48841,"journal":{"name":"Clinical Interventions in Aging","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453164/pdf/","citationCount":"0","resultStr":"{\"title\":\"Association Between Blood-Brain Barrier Disruption and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients After Endovascular Therapy: A Retrospective Cohort Study.\",\"authors\":\"Haojun Ma, Rui Chen, Nannan Han, Hanming Ge, Shilin Li, Yanfei Wang, Xudong Yan, Chengxue Du, Yanjun Gao, Gejuan Zhang, Mingze Chang\",\"doi\":\"10.2147/CIA.S475887\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Stroke, particularly due to large vessel occlusion (LVO), is a major cause of mortality and disability globally. Endovascular therapy (ET) significantly improves outcomes for acute ischemic stroke (AIS) patients, but complications such as stroke-associated pneumonia (SAP) increase mortality and healthcare costs. This study investigates the association between blood-brain barrier (BBB) disruption and the increased risk of SAP and explores the relationship between BBB disruption and medium-term functional outcomes.</p><p><strong>Methods: </strong>The retrospective cohort study was performed on AIS patients enrolled between January 2019 to February 2023 who underwent ET. Patients were divided into two groups: BBB disruption and without BBB disruption. Multiple logistic regression model was conducted to measure the association between BBB disruption and SAP. Mediation analysis was used to estimate the potential mediation effects on the associations of BBB disruption with SAP. A restricted cubic spline (RCS) regression model was used to further outline the connection between the highest CT value of hyperattenuated lesions areas and the risk of SAP.</p><p><strong>Results: </strong>The study included 254 patients who underwent endovascular therapy, with 155 patients in the BBB disruption group (exposure) and 99 patients in the without BBB disruption group (control). Multiple logistic regression analysis revealed a significantly increased risk of SAP in patients with BBB disruption (OR = 2.337, 95% CI: 1.118-4.990, p = 0.025). Furthermore, mediation analysis suggested that this association may be partly due to malignant cerebral oedema and haemorrhagic transformation. The study found an inverse L-shaped dose-response relationship between the maximum CT values of BBB disruption areas and the incidence of SAP. SAP partially mediated the association between BBB disruption and 3-month poor functional outcome.</p><p><strong>Conclusion: </strong>BBB disruption are a potential risk factor for SAP. BBB disruption may affect short- and medium-term prognosis of patients after ET in part through SAP.</p>\",\"PeriodicalId\":48841,\"journal\":{\"name\":\"Clinical Interventions in Aging\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.5000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11453164/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Interventions in Aging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/CIA.S475887\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Interventions in Aging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/CIA.S475887","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：中风，尤其是大血管闭塞（LVO）导致的中风，是全球死亡和残疾的主要原因。血管内治疗（ET）能显著改善急性缺血性中风（AIS）患者的预后，但中风相关肺炎（SAP）等并发症会增加死亡率和医疗成本。本研究调查了血脑屏障（BBB）破坏与 SAP 风险增加之间的关系，并探讨了 BBB 破坏与中期功能预后之间的关系：该回顾性队列研究的对象是2019年1月至2023年2月期间入组并接受ET的AIS患者。患者分为两组：BBB破坏组和无BBB破坏组。采用多元逻辑回归模型测量 BBB 破坏与 SAP 之间的关联。中介分析用于估计 BBB 干扰与 SAP 关联的潜在中介效应。采用受限立方样条线（RCS）回归模型进一步勾勒出高衰减病灶区域的最高CT值与SAP风险之间的联系：研究纳入了254名接受血管内治疗的患者，其中155名患者属于BBB破坏组（暴露组），99名患者属于无BBB破坏组（对照组）。多元逻辑回归分析表明，BBB破坏的患者发生SAP的风险明显增加（OR = 2.337，95% CI：1.118-4.990，p = 0.025）。此外，中介分析表明，这种关联的部分原因可能是恶性脑水肿和出血性转化。研究发现，BBB破坏区域的最大CT值与SAP发病率之间存在反L型剂量反应关系。SAP在一定程度上介导了BBB破坏与3个月不良功能预后之间的关系：结论：BBB破坏是SAP的潜在风险因素。结论：BBB破坏是SAP的潜在风险因素，BBB破坏可能会部分通过SAP影响ET患者的短期和中期预后。
Association Between Blood-Brain Barrier Disruption and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients After Endovascular Therapy: A Retrospective Cohort Study.
Background: Stroke, particularly due to large vessel occlusion (LVO), is a major cause of mortality and disability globally. Endovascular therapy (ET) significantly improves outcomes for acute ischemic stroke (AIS) patients, but complications such as stroke-associated pneumonia (SAP) increase mortality and healthcare costs. This study investigates the association between blood-brain barrier (BBB) disruption and the increased risk of SAP and explores the relationship between BBB disruption and medium-term functional outcomes.
Methods: The retrospective cohort study was performed on AIS patients enrolled between January 2019 to February 2023 who underwent ET. Patients were divided into two groups: BBB disruption and without BBB disruption. Multiple logistic regression model was conducted to measure the association between BBB disruption and SAP. Mediation analysis was used to estimate the potential mediation effects on the associations of BBB disruption with SAP. A restricted cubic spline (RCS) regression model was used to further outline the connection between the highest CT value of hyperattenuated lesions areas and the risk of SAP.
Results: The study included 254 patients who underwent endovascular therapy, with 155 patients in the BBB disruption group (exposure) and 99 patients in the without BBB disruption group (control). Multiple logistic regression analysis revealed a significantly increased risk of SAP in patients with BBB disruption (OR = 2.337, 95% CI: 1.118-4.990, p = 0.025). Furthermore, mediation analysis suggested that this association may be partly due to malignant cerebral oedema and haemorrhagic transformation. The study found an inverse L-shaped dose-response relationship between the maximum CT values of BBB disruption areas and the incidence of SAP. SAP partially mediated the association between BBB disruption and 3-month poor functional outcome.
Conclusion: BBB disruption are a potential risk factor for SAP. BBB disruption may affect short- and medium-term prognosis of patients after ET in part through SAP.
期刊介绍：
Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.
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