摘要
目的探讨基于血管选择性动脉自旋标记(territorial arterial spin labeling,TASL)技术的急性前循环缺血性脑卒中(acute anterior circulation ischemic stroke,AACIS)药物治疗预后因素的影响性分析。材料与方法回顾性连续纳入确诊AACIS患者136例并根据其治疗后90 d的预后情况分为预后良好(70例)与预后不良(66例)两组。记录责任血管狭窄度、疗前选择性脑血流量(territorial cerebral blood flow,TCBF)、疗后TCBF_(10 d)、相对选择性脑血流量(relative CBF,rTCBF)以及病灶体积,同时收集患者的基线美国国立卫生研究院卒中量表评分(National Institute of Health Stroke Scale,NIHSS)、卒中分型、年龄、性别、身体质量指数等风险因素信息,将上述指标纳入统计模型。对两组间的计量资料使用Mann-Whitney U检验、计数资料使用χ^(2)检验统计其单因素差异性,对具有统计学意义的指标进行多因素联合logisitic回归分析,使用受试者工作特性曲线(receiver operating characteristic curve,ROC)对结果进行诊断效能评判。结果单因素分析中,年龄(Z=16.022)、基线NIHSS评分(Z=148.400)、卒中分型(Z=49.640)、责任血管狭窄度(Z=27.193)、TCBF_(疗前)(Z=693.000)、rTCBF(Z=18.874)及病灶体积(Z=-10.140)差异均有统计学意义(P<0.05)。多因素联合分析中,年龄(OR=0.108)、基线NIHSS评分(OR=0.615)、卒中分型中的穿支动脉疾病(OR=90.154)、TCBF_(疗前)(OR=4.611)及病灶体积(OR=0.138)对预后具有显著影响(P<0.05),且5者联合对预后预测的判定方法切实有效(P<0.05),ROC曲线下面积为0.962,具有较高价值。责任血管灌注的改变对预后无显著影响(P>0.05)。结论在药物保守治疗方法下,患者90 d预后更易受到年龄、基线NIHSS评分、卒中种类、CBF_(疗前)及病灶体积的影响,并不依赖于责任血管的灌注改善情况。
Objective:To explore the impact of prognostic factors of acute anterior circulation ischemic stroke(AACIS)after conservative drug treatment based on territorial arterial spin labeling(TASL)technology.Materials and Methods:Retrospectively,a total of 136 patients with confirmed AACIS were consecutively collected and divided into two groups:good prognosis(70 cases)and poor prognosis(66 cases)according to their prognosis after 90 d treatment.The degree of stenosis of the responsible vessel,territorial cerebral blood flow(TCBF)before treatment,TCBF_(10 d)after treatment,relative CBF(rTCBF)and the lesion volume were recorded.Simultaneously,baseline national institute of health stroke scale(NIHSS),age,gender,stroke classification,body mass index and other risk factor information from patients were collected.Incorporate the above indicators into the statistical model.The measurement data between the two groups were analyzed using Mann Whitney U test,and the counting data were analyzed usingχ^(2)test for univariate differences.Multivariate joint logistic regression analysis was performed on statistically significant indicators,and receiver operating characteristic curve(ROC)was used to evaluate the diagnostic efficacy of the results.Results:In univariate analysis,there were significant differences in age(Z=16.022),baseline NIHSS score(Z=148.400),stroke classification(Z=49.640),responsible vessel stenosis(Z=27.193),baseline TCBF_(pre-treatment)(Z=693.000),rTCBF(Z=18.874)and lesion volume(Z=−10.140)between the two groups(P<0.05).In multivariate joint analysis,age(OR=0.108),baseline NIHSS score(OR=0.615),perforating artery disease of stroke classification(OR=90.154),TCBF_(pre-treatment)(OR=4.611)and lesion volume(OR=0.138)had significant impact on prognosis(P<0.05).The combination of the four methods for predicting prognosis was effective(P<0.05),and the area under the ROC curve was 0.962,which has high value.The changes in responsible vascular perfusion have no significant impact on prognosis(P>0.05).Conclusions:With drug conservative treatment,the 90 d prognosis of patients was more likely to be affected by age,baseline NIHSS,stroke classification,TCBF_(pre-treatment) and lesion volume,but not related to the improvement of responsible vascular perfusion.
作者
李小雷
单春辉
赵明娟
张晖
暴云锋
陈英敏
LI Xiaolei;SHAN Chunhui;ZHAO Mingjuan;ZHANG Hui;BAO Yunfeng;CHEN Yingmin(Hebei Provincial Center for Disease Control and Prevention,Shijiazhuang 050000,China;Department of Medical Imaging,Hebei Province General Hospital,Shijiazhuang 050051,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2024年第5期28-33,共6页
Chinese Journal of Magnetic Resonance Imaging
基金
河北省医学科学研究课题计划项目(编号:20190301)。
关键词
急性前循环缺血性脑卒中
药物治疗
磁共振成像
血管选择性动脉自旋标记
脑血流量
acute anterior circulation ischemic stroke
drug conservative treatment
magnetic resonance imaging
territorial arterial spin labeling
cerebral blood flow
