多时相CTA联合CTP对急...神经功能预后不良的预测分析_冉晓波.pdf

33临床研究 2023 年 03 月第 31 卷第 03 期作者简介：冉晓波，男，副主任医师，本科。研究方向：双源 CT 对左心耳血栓的评价。论著多时相 CTA 联合 CTP 对急性脑梗死近期神经功能预后不良的预测分析冉晓波1，詹浩辉2，杨俊霞2(1.洛阳市偃师人民医院 CT、MRI室，河南 洛阳 471900；2.河南科技大学第二附属医院 影像科，河南 洛阳 471000)摘要：目的 探讨多时相计算机断层扫描血管成像(CTA)联合计算机断层扫描灌注成像(CTP)对急性脑梗死近期神经功能预后不良的预测价值。方法 选取洛阳市偃师人民医院 2020 年 1 月至 2022 年 6 月收治的 187 例急性脑梗死患者，治疗后均实施多时相 CTA 和 CTP 检查，并随访 3 个月。根据随访结果，剔除 15 例患者，将患者分为预后不良组(N=34)和预后良好组(N=138)。比较预后不良与预后良好组的多时相 CTA、CTP 检查结果 Logistic 回归分析患者近期神经功能预后不良的因素；受试者工作特征(ROC)曲线评价多时相 CTA 联合 CTP 对患者近期神经功能不良的预测价值。结果 患者近期预后不良发生率为 19.77%；预后不良组区域软脑膜评分(rLMC)、脑血流量(CBF)、脑血容量(CBV)均低于预后良好组，差异有统计学意义(P 0.05)，达峰时间(TTP)和平均通过时间(MTT)均长于预后良好组，差异有统计学意义(P 0.05)。年龄、合并糖尿病、合并高血压、合并高脂血症、发病至溶栓时间、美国国立卫生院(NIHSS)量表评分、未遵医嘱治疗、rLMC 评分、CBF、CBV、TTP、MTT 均是患者近期预后不良的影响因素，差异有统计学意义(P 0.05)。多时相 CTA、CTP 各参数预测患者近期不良的灵敏度、特异度、曲线下面积(AUC)均高于 NIHSS，差异有统计学意义(P 0.05)。多时相 CTA 联合 CTP 预测患者近期不良的灵敏度、AUC 均高于单独预测，差异有统计学意义(P 0.05)。结论 急性脑梗死近期神经功能预后不良风险高，影响因素多，且多时相 CTA联合 CTP 对其预测效能高。关键词：多时相计算机断层扫描血管成像；计算机断层扫描灌注成像；急性脑梗死；神经功能；预后不良中图分类号：R743.33文献标志码：A DOI：10.12385/j.issn.2096-1278(2023)03-0033-06Predictive Analysis of the short-term poor Prognosis of neurological Function in acute cerebral Infarction by multi-phase CTA combined with CTPRAN Xiaobo1,ZHAN Haohui2,YANG Junxia2(1.Department of CT and MRI,Luoyang Yanshi Peoples Hospital,Luoyang Henan 471900,China;2.Department of Imaging,The Second Affiliated Hospital of Henan University of Science and Technology,Luoyang Henan 471000,China)Abstract:Objective To explore the predictive value of multi-phase computed tomography angiography(CTA)combined with computed tomography perfusion imaging(CTP)for the poor prognosis of neurological function in acute cerebral infarction.Methods A total of 187 patients with acute cerebral infarction admitted to Luoyang Yanshi Peoples Hospital from January 2020 to June 2022 were selected.After treatment,all patients were examined by multi-temporal CTA and CTP,and were followed up for 3 months.According to the follow-up results,15 patients were excluded and the remaining patients were divided into poor prognosis group(N=34)and good prognosis group(N=138).The results of multiple-phase CTA and CTP in the patients with poor prognosis and those with good prognosis was compared.Logistic regression analysis was used to analyze the factors of poor prognosis of neurological function in the patients;Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of multi-temporal CTA combined with CTP in patients with recent poor neurological function.Results The incidence of poor prognosis was 19.77%;The regional leptomeningeal score(rLMC),cerebral blood fiow(CBF)and cerebral blood volume(CBV)in the poor prognosis group were lower than those in the good prognosis group,with statistical significance(P 0.05),the peak time(TTP)and the mean transit time(MTT)were significantly longer than those in the good prognosis group,the difference was statistically significant(P 0.05).Age,combined diabetes,combined hypertension,combined hyperlipidemia,time from onset to thrombolysis,national institutes of health(NIHSS)scale score,on-following medical advice,rLMC score,CBF,CBV,TTP,MTT were all the infiuencing factors of poor short-term prognosis of patients,and the difference was statistically significant(P 0.05).The sensitivity,specificity and area under curve(AUC)of the parameters of multi-temporal CTA and CTP in predicting the short-term adverse events of patients were higher than those of NIHSS,and the difference was statistically significant(P 0.05).The sensitivity and AUC of multi-temporal CTA combined with CTP in predicting patients short-term adverse events were higher than that of single prediction,and the difference was statistically significant(P0.05).Conclusion The risk of poor prognosis of neurological function in acute cerebral infarction in the near future is high,and there are many infiuencing factors,and the prediction effect of multi-phase CTA combined with CTP is high.Key Words:multi-phase computed tomography angiography;computed tomography perfusion imaging;acute cerebral infarction;nerve function;poor prognosis急性脑梗死是指由于脑部供血急性中断而导致的相应区域内神经细胞变性、坏死，进而引发相应脑区神经功能障碍的一种急性脑血管病，其致残率和死亡率高。流行病学资料显示1，我国急性脑梗死的发病率约为110/10 万，位居世界之首。另有资料指出2，我国每 5个成年人中就有 1 个死于脑梗死，该病被称为我国居民34Clinical Research,Mar.2023,Vol.31 No.03的“头号健康杀手”。急性脑梗死神经功能缺损且预后差，即使经过及时对症治疗后也有 50%致残3。有研究显示4-5，急性脑梗死患者预后不良发生率为 41.25%，且老年急性脑梗死短期预后不良发生率为 24.32%。而探讨患者近期神经功能预后不良的方法十分必要。但是目前临床多根据患者的症状及表现评估，缺乏规范的方法和标准6。多时相计算机断层扫描血管成像(CTA)和计算机断层扫描灌注成像(CTP)均是常用的评价急性脑梗死侧支循环形成的方法，有研究显示7二者可指导介入治疗和预后评估。但二者联合是否可提高对急性脑梗死近期神经功能预后不良的预测价值尚不清楚。基于此，本研究选取 187 例患者探讨上述问题，以期能够为其提供一种合理的近期预后不良预测方案。1资料与方法1.1一般资料选取洛阳市偃师人民医院 2020 年 1 月至 2022 年6 月收治的 187 例急性脑梗死患者，男 101 例，女 86例；年 龄 42 80 岁，平 均(61.6510.97)岁；有 吸烟史 90 例(一生中连续或累积抽烟 6 个月)；有饮酒史 68 例(男性平均每天饮酒 40mg，女性平均每天饮酒 20mg)；合并糖尿病 102 例；合并高血压 104 例；合并高脂血症 101 例；合并房颤 16 例；梗死灶：单发62 例、多发 125 例；发病至溶栓时间 1.0 6.0h，平均(2.880.62)h；美国国立卫生院(NIHSS)神经功能缺损量表8评分 7 20 分，平均(10.982.26)分；血红蛋白 71 168g/L，平均(138.5527.15)g/L；白细胞 4.6109/L 12.4109/L，平均(8.801.21)10