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目的 探索新的基底动脉影像学评分方法——基于MRA评估基底动脉闭塞预后评分（basilar artery occlusion prognosis score on magnetic resonance angiography，BAOPS-MRA）及其对非重症基底动脉闭塞患者预后的评估效果。 方法 提出基于MRA的新型基底动脉评分方法——BAOPS-MRA及其动脉节段评分标准。前瞻性连续入组2019年1月-2020年12月经头颅MRA诊断为基底动脉闭塞且NIHSS≤15分的后循环缺血性卒中患者，在该患者群体中评估BAOPS-MRA预测发病3个月功能预后的效能。根据发病3个月的随访结果，将患者分为预后良好（mRS≤2分）组和预后不良（mRS＞2分）组，基于患者入院时的MRA结果，评定BAOPS-MRA，同时评定既往研究者提出的基于MRA的基底动脉和侧支循环的评分（basilar artery and collateration score on magnetic resonance angiography，BACS-MRA）。采用单因素和多因素方法分析两组的基线资料、血管狭窄部位和程度、BAOPS-MRA、BACS-MRA与3个月预后的关系。采用ROC曲线评估BAOPS-MRA预测患者预后的效能，并与BACS-MRA的预测效能进行比较。对BAOPS-MRA、BACS-MRA与发病3个月预后进行相关性分析。 结果 共纳入99例患者，其中预后良好组65例，预后不良组34例。预后良好组的BAOPS-MRA评分为7.0（2.0～16.0）分，预后不良组为2.5（0～12.0）分。多因素分析显示，BAOPS-MRA（OR 1.577，95%CI 1.238～2.008，P=0.001）、BACS-MRA（OR 1.488，95%CI 1.193～1.857，P=0.001）、NIHSS（OR 0.786，95%CI 0.670～0.923，P=0.003）是患者3个月功能预后的独立影响因素。ROC曲线分析显示，BAOPS-MRA评分预测3个月预后的截断值为5分，AUC为0.850（95%CI 0.765～0.936），敏感度为0.794，特异度为0.754；BACS-MRA预测3个月预后的截断值为4分，AUC为0.747（95%CI 0.641～0.852），敏感度为0.765，特异度为0.585，BAOPS-MRA较BACS-MRA的预测效能更佳。BAOPS-MRA（rs=0.580，P＜0.001）、BACS-MRA（rs=0.409，P＜0.001）与患者3个月预后良好呈正相关性。 结论 BAOPS-MRA评分可独立预测非重症基底动脉闭塞患者的3个月功能预后，具有一定的临床推广价值。 Abstract: Objective To evaluate the predictive value of a new basilar artery occlusion prognosis score based on MRA the basilar artery occlusion prognosis score on magnetic resonance angiography (BAOPS-MRA) for the 90-day functional prognosis of patients with non-severe basilar artery occlusion. Methods We proposed the scoring method based on MRA of BAOPS-MRA score. This prospective cohort enrolled the consecutive patients with posterior circulation ischemic stroke diagnosed with basilar artery occlusion and NIHSS ≤15 from January 2019 to December 2020. According to the follow-up results at 3 months of stroke onset, the patients were divided into good prognosis (mRS≤2) group and poor prognosis (mRS >2) group. Based on MRA results at admission, the BAOPS-MRA score, and the basilar artery and collateral circulation score on MRA (BACS-MRA) score were evaluated. Multivariate logistic regression analysis was performed to analyze the relationship between baseline data, BAOPS-MRA, BACS-MRA and 90-day prognosis. The ROC curve was used to evaluate the predictive efficacy of the two scores for 90-day prognosis, and the predictive value of the two scores was compared. Spearman correlation analysis was used to analyze the correlation of BAOPS-MRA and BACS-MRA with 90-day mRS. Results A total of 99 patients were included, including 65 in good prognosis group and 34 in poor prognosis group. The BAOPS-MRA score was 7.0 (2.0-16.0) in good prognosis group and 2.5 (0-12.0) in poor prognosis group. Multivariate analysis showed that BAOPS-MRA (OR 1.577, 95%CI 1.238-2.008, P=0.001), BACS-MRA (OR 1.488, 95%CI 1.193-1.857, P=0.001), NIHSS (OR 0.786, 95%CI 0.670-0.923, P=0.003) were independent predictors of functional outcome at 3 months. ROC curve analysis showed that the cut-off value of BAOPS-MRA score for predicting 90-day prognosis was 5, the area under the curve (AUC) was 0.850 (95%CI 0.765-0.936), the sensitivity was 0.794, and the specificity was 0.754; the cut-off value of BACS-MRA for predicting 90-day prognosis was 4, the AUC was 0.747 (95%CI 0.641-0.852), the sensitivity of 0.765, and the specificity was 0.585. BAOPS-MRA was better than BACS-MRA in predicting 90-day functional prognosis of patients with basilar artery occlusion. BAOPS-MRA (rs=0.580, P |
