摘要
目的应用动态四维CT血管造影(4D-CTA)评价急性缺血性脑卒中(AIS)患者脑侧支循环状态并分析患者脑侧支循环状态与其预后的相关性。方法收集2020年1月至9月江苏省滨海县人民医院最终纳入研究的47例AIS患者的基线资料及影像学变量资料。所有患者均于发病4.5h内接受4D-CTA检查,应用多时相CTA(mCTA)脑侧支循环评分与区域软脑膜侧支循环(rLMC)评分对AIS患者脑侧支循环状态进行评估,并采用90 d改良Rankin量表(mRS)评估其神经功能预后。根据mRS评分结果将患者分为侧支循环不良组(19例)与侧支循环良好组(28例)。采用SPSS 25.0软件分析数据,根据数据类型,分别采用χ^(2)检验、t检验或秩和检验进行组间比较。采用Spearman相关分析各指标间的相关性。应用logistic回归分析影响AIS患者神经功能预后不良的指标,并进一步绘制受试者工作特征(ROC)曲线探讨不同指标的预测价值。结果与侧支循环良好组相比,侧支循环不良组美国国立卫生研究院卒中量表(NIHSS)评分更高,半影体积(Tmax>6 s)及梗死核心体积(rCBF<30%)更大,错配比更小,mCTA评分、rLMC评分及90d mRS评分更低(P<0.05)。mCTA评分与基线NIHSS评分、半影体积(Tmax>6 s)、梗死核心体积(rCBF<30%)、错配比呈负相关;与rLMC评分、90 d mRS评分呈正相关。rLMC评分与基线NIHSS评分、半影体积(Tmax>6s)、梗死核心体积(rCBF<30%)、错配比、90 d mRS评分均呈负相关;与mCTA评分呈正相关。多因素logistic回归分析显示,mCTA评分、基线NIHSS评分均是预测AIS患者神经功能预后不良的指标。ROC结果显示,mCTA评分+基线NIHSS评分联合预测AIS患者神经功能预后不良的价值较单一指标更佳,ROC曲线下面积(AUC)为0.918,灵敏度为89.6%,特异度为92.4%。结论mCTA评分+基线NIHSS评分预测AIS患者的神经功能预后具有更好的价值,当mCTA脑侧支循环评分≤3分、基线NIHSS评分>5分时,预示AIS患者神经功能预后不良。
Objective To evaluate the collateral circulation status with four-dimensional computed tomography angiography(4D-CTA)after acute ischemic stroke(AIS)and analyze its correlation with prognosis.Methods Baseline data and imaging data of 47 AIS patients who admitted in our hospital from January to September 2020 and finally included in this study were collected and analyzed.All of them received 4D-CTA within 4.5 h after onset.The level of cerebral collateral circulation was assessed by multiphase CT angiography(mCTA)scores and regional leptomeningeal collateral(rLMC)scores.The 90-day modified Rankin score(mRS)was used to evaluate the neurological prognosis,and the patients were divided into poor collateral circulation group(n=19)and good collateral circulation group(n=28)according to mRS.SPSS statistics 25.0 was used to analyze the data,and Chi-square test,student′s t test or rank sum test was used for inter-comparison depending on data types.Spearman correlation analysis was employed for the correlations among indicators.Logistic regression analysis was performed to analyze the factors affecting poor neurological prognosis in AIS patients.Receiver operating characteristic(ROC)curve was drawn to assess the predictive values of these indicators.Results Compared with the good collateral circulation group,the poor collateral circulation group had significantly higher National Institutes of Health Stroke Scale(NIHSS)score,larger penumbra volume(Tmax>6 s)and infarct core volume(rCBF<30%),smaller mismatch ratio,lower mCTA score,rLMC score and 90-day mRS score(P<0.05).mCTA score was negatively correlated with baseline NIHSS score,penumbra volume(Tmax>6 s),infarct core volume(rCBF<30%),and mismatch ratio,and positively correlated with rLMC score and 90-day mRS score.rLMC score had negative correlations with baseline NIHSS score,penumbra volume(Tmax>6 s),infarct core volume(rCBF<30%),mismatch ratio,and 90-day mRS score,and positive correlation with mCTA score.The results of multiva-riate logistic regression analysis showed that mCTA score and baseline NIHSS score were both predictors of poor neurological prognosis in AIS patients.ROC curve indicated that combination of mCTA score+baseline NIHSS score showed better predictive values for poor neurological prognosis in AIS patients than a single index,with an area under the ROC curve(AUC)of 0.918,a sensitivity of 89.6%,and a specificity of 92.4%.Conclusion mCTA score+baseline NIHSS score has a better value for predicting the poor neuro-logical prognosis in AIS patients.When the mCTA cerebral collateral circulation score less than 3 and the baseline NIHSS score greater than 5,it indicates that neurological prognosis is poor in the patients.
作者
陶景山
臧晓进
戴益盛
刘斌
TAO Jing-Shan;ZANG Xiao-Jin;DAI Yi-Sheng;LIU Bin(Department of Imaging,People′s Hospital of Binhai County,Binhai 224500,Jiangsu Province,China)
出处
《中华老年多器官疾病杂志》
2022年第6期443-448,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
基金
南京医科大学康达学院科研课题(KD2021KYJJZD079)
盐城市医学科技发展计划(YK2020081)。
