Department of Neurology, The Affiliated Hospital of Northwest University, Xi'an No.3 hospital, Xi'an, People's Republic of China.
Xi'an Key Laboratory of Cardiovascular and Cerebrovascular Diseases, The Affiliated Hospital of Northwest University, Xi'an No.3 hospital, Xi'an, People's Republic of China.
Clin Interv Aging. 2024 Oct 1;19:1611-1628. doi: 10.2147/CIA.S475887. eCollection 2024.
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.
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.
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.
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.
脑卒中，特别是大动脉闭塞性脑卒中（LVO），是全球范围内导致死亡率和残疾的主要原因。血管内治疗（ET）显著改善了急性缺血性脑卒中（AIS）患者的预后，但并发症如卒中相关性肺炎（SAP）会增加死亡率和医疗成本。本研究旨在探讨血脑屏障（BBB）破坏与 SAP 风险增加之间的关系，并探索 BBB 破坏与中期功能结局之间的关系。
本回顾性队列研究纳入了 2019 年 1 月至 2023 年 2 月期间接受 ET 的 AIS 患者。患者被分为 BBB 破坏组和未破坏组。采用多因素逻辑回归模型来衡量 BBB 破坏与 SAP 之间的关联。采用中介分析来估计 BBB 破坏与 SAP 之间关联的潜在中介效应。采用受限立方样条（RCS）回归模型进一步探讨 BBB 破坏的最高 CT 值与 SAP 风险之间的关系。
研究纳入了 254 名接受血管内治疗的患者，其中 155 名患者存在 BBB 破坏（暴露组），99 名患者不存在 BBB 破坏（对照组）。多因素逻辑回归分析显示，BBB 破坏患者发生 SAP 的风险显著增加（OR=2.337，95%CI：1.118-4.990，p=0.025）。此外，中介分析表明，这种关联可能部分归因于恶性脑水肿和出血性转化。研究发现 BBB 破坏区最大 CT 值与 SAP 发生率之间存在反向 L 形剂量反应关系。SAP 部分介导了 BBB 破坏与 3 个月预后不良之间的关联。
BBB 破坏是 SAP 的潜在危险因素。BBB 破坏可能通过 SAP 部分影响 ET 后患者的短期和中期预后。
