摘要
目的研究大脑中动脉高密度征预测急性缺血性卒中患者大血管闭塞的准确性和与临床结局的相关性。方法连续性纳入2015年7月至2017年7月,在发病后6h内到达四川大学华西医院卒中中心的急性缺血性卒中患者。使用logistic回归分析大脑中动脉高密度征与大血管闭塞、脑梗死后出血转化和出院3月预后的相关性,应用受试者工作特征曲线的曲线下面积(AUC)分析其预测能力。结果一共纳入292名急性缺血性卒中患者。在早期多模态头颅CT可见,50例(17.1%)存在大脑中动脉致密征,其中41例(82.0%)存在大血管闭塞。大脑中动脉致密征(OR=8.93,95%CI:3.72~21.48,P<0.001)与大血管闭塞相关,并且预测能力优于早期CT显影梗死灶(AUC0.682vs.0.602,P=0.038)。在对临床结局的分析中,大脑中动脉致密征是脑梗死后出血转化的独立危险因素(OR=5.32,95%CI:2.16~13.11,P<0.001),但其AUC未高于房颤(0.685vs.0.651,P=0.579);大脑中动脉致密征是3月后神经功能恢复差的独立危险因素(OR=3.02,95%CI:1.19~7.62,P=0.019),但其AUC和早期CT梗死灶(0.642vs.0.619,P>0.05)相当。结论大脑中动脉致密征增加大血管闭塞可能性和脑梗塞后出血转化风险,患者远期神经功能恢复差。
Objective To determine the associations between hyperdense middle cerebral arteries sign （HMCAS） and large vessel occlusion （LVO） and clinical outcomes in patients with acute ischemic stoke. Methods Patients who were admitted to the Stroke Center of West China Hospital of Sichuan University within 6 h after onset of acute ischemic stroke from July 2015 to July 2017 were included in this study. Logistic regression models were established to determine the value of HMCAS in predicting LVO, hemorrhagic transformation and 90-d functional outcome using the receiver operating characteristic curve. Results A total of 292 stroke patients were recruited and 50 （17. 1%） presented with HMCAS, including 41 （82.0K） with confirmed as LVO. HMCAS had a value of 0. 682 in the area under the receiver operating characteristic curve for predicting LVO [odds ratio （OR）= 8. 93, 95% confidence interval （CI）：3.72-21.48, P〈0.001）, better than early CT infarct （0.682 vs. 0.602, P= 0. 038）. HMCAS was also an independent predictor for hemorrhagic transformation （OR= .32, 95%CI： 2. 16-13.11, P〈0. 001） and poor functional recovery （OR= 3.02, 95% CI： 1. 19-7. 62, P=0. 019）. Conclusion HMCAS is a risk factor of large artery occlusion, hemorrhagic transformation, and poor functional recovery in patients with acute ischemic stroke.
作者
郭毅佳
朱加应
洪烨
何俐
GUO Yi-jia;ZHU Jia-ying;HONG Ye;HE Liz(Department of Neurology,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2018年第5期743-748,共6页
Journal of Sichuan University(Medical Sciences)
基金
国家自然科学基金(No.81571153)资助
关键词
急性缺血性卒中
大脑中动脉高密度征
大血管闭塞
预后
Acute ischemic stroke
Hyperdense middle cerebral arteries sign
Large vessel occlusion Prognosis
