应用ASPECTS评价影响大脑中动脉狭窄患者支架置入术前后CT灌注的相关因素  

Evaluations of relevant factors affecting preoperative and postoperative CT perfusion with ASPECTS in patients receiving stent implantation for middle cerebral artery stenosis

作　　者：曲辉[1] 张长青[2] 董可辉[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,100050 [2]北京普仁医院神经内科,100062

出　　处：《实用医学杂志》2008年第13期2217-2219,共3页The Journal of Practical Medicine

基　　金：十一五国家科技支撑计划课题(编号:2006BAI01A11)

摘　　要：目的:研究大脑中动脉狭窄患者支架置入术前后影响头颅CT灌注的相关因素。方法:选择25例2004年1月1日至2007年3月1日在天坛医院行大脑中动脉支架置入术的脑血管病患者,使用Alberta StrokeProgram Early CT Score(ASPECTS)量表对手术前后头颅CT灌注的最大峰值时间(TTP)情况进行评分,并对可能影响支架置入术前后CT灌注的因素进行分析。结果:25名入选者术前TTP与对侧比均明显延长,术后所有患者TTP较术前均有不同程度好转。TTP术前ASPECTS评分为(2.32±1.31)分,术后ASPECT评分为(8.28±1.65)分,两者差异有非常显著性(P<0.001)。术前ASPECTS评分与大脑中动脉的狭窄程度呈负相关(r=-5.78)。对可能影响支架置入术前后CT灌注改善程度的相关因素进行分析,只有是否存在良好的侧支循环亚组间比较差异有显著性(P=0.033),术前罪犯血管狭窄率与CT灌注ASPECT评分改善程度正相关(r=1.137,P=0.001)。结论:TTP是评价大脑中动脉支架置入术效果的一种敏感方法,使用ASPECT量表可以对手术前后的头颅TTP情况进行定量评价。对于狭窄严重或缺乏良好侧支循环的患者支架治疗的获益可能更大。Objective To investigate relevant factors affecting cerebral CT perfusion （CTP） before and after stent implantation in patients with middle cerebral artery stenosis. Methods 25 cases of ischemic cerebrovascular disease patients who received middle cerebral artery stent implantation in Beijing Tiantan Hospital were chosen, Alberta Stroke Program Early CT Score（ASPECTS） was used to evaluate the time to peak （TTP） of CTP before and after stent implantation, and factors which might potentially affect preoperative and postoperative CTP assessments were analyzed. Results Preoperative TTPs for all of the 25 patients were remarkably delayed than contral cerebral hemisphere, and postoperative TTPs for all of the 25 patients were improved compared with preoperative results. The preoperative TTP ASPECTS score was 2.32 ± 1.31, postoperative ASPECTS score was 8.28 ± 1.65, and the paired t test demonstrated that there was a statistically significant difference （P 〈 0.001 ）. Preoperative ASPECTS score was negatively correlated with middle cerebral artery stenosis with a correlation coefficient of -5.78. Relevant factors which may affect the improvement of CTP after stent implantation were analyzed, significant difference was only found between the presence and absence of good collateral circulation （P = 0.033）. Preoperative stenosis rate was positively correlated with the improvement of ASPECT score for TTP, with a correlation coefficient of 1.137 （P = 0.001）. Conclusion TTP is a sensitive assessment for the evaluation of middle cerebral artery stent implantation, and preoperative and postoperative TIP may be quantitatively evaluated with ASPECT score. Patients with severe stenosis or without good collateral circulation may benefit more from stent implantation.

关 键 词：脑动脉疾病 CT灌注 达峰时间 支架 

分 类 号：R743.3[医药卫生—神经病学与精神病学]