动态CT血管造影评估急性缺血性卒中患者侧支血流与静脉溶栓预后的关系  

Dynamic CT angiography in evaluation of collateral flow and outcome of acute ischemic stroke patients after intravenous thrombolysis

作　　者：陈伟莉[1] 丁信法[2] 张圣[1] 虞雁南 陈智才[1] 楼敏[1] 

机构地区：[1]浙江大学医学院附属第二医院神经内科,浙江杭州310009 [2]浙江大学医学院附属第二医院放射科,浙江杭州310009

出　　处：《浙江大学学报（医学版）》2014年第1期14-19,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省杰出青年科学基金(LR12H09001);浙江省科技厅重大科技专项计划(2013C13G2010032)

摘　　要：目的:建立动态CT血管造影(CTA)评估急性缺血性卒中患者侧支血流的方法,并分析侧支血流与静脉溶栓治疗预后的关系。方法:回顾性分析大脑中动脉M1段或颈内动脉闭塞的22例急性缺血性卒中患者的CT灌注成像,根据动态CTA影像评估侧支血流的范围、速度。用重复度量检验分析不同侧支血流之间美国国立卫生研究院卒中量表(NIHSS)评分的差异,用非参数spearman相关检验分析其与溶栓后3个月改良Rankin量表(mRS)评分的相关性。结果:与侧支血流总体情况差的患者相比,侧支血流总体情况好的患者溶栓后1个月内NIHSS评分更低[(4.7±5.0)与(25.1±15.1)分,P=0.001],再灌注率更高(69%±32%与23%±54%,P=0.044);3个月mRS评分与侧支血流总体情况得分存在显著正相关(r=0.450,P=0.001)。结论:侧支血流好的急性缺血性卒中患者静脉溶栓后临床预后好。应用动态CTA评估侧支血流可用于预测临床预后。Objective： To evaluate the collateral flow of patients with acute ischemicstroke by dynamic CT angiography （CTA） and to analyze the relationship between collateral flow and outcome after intravenous thrombolysis. Methods： We retrospectively analyzed CT perfusion （CTP） imaging of 22 acute ischemic stroke patients with middle cerebral artery （MCA） or internal carotid artery （ICA） occlusion undergoing intravenous thrombolysis, and reconstructed the images for dynamic CTA in the Second Affiliated Hospital, Zhejiang University School of Medicine from June 2009 to October 2013. The total extent and flow speed of collateral flow based on dynamic CTA images of these patients were evaluated. The scores of National Institute of Health stroke scale （ NIHSS ） in different collateral flows were compared with repeated measuring. The nonparametric Spearman ＇s rank correlation was used to assess the relationship between collateral flow and modified Rankin scale （mRS） at 3 months after thrombolytic therapy. Results： Compared with the poor collateral flow group, patients with good collateral flow had lower NIHSS at 1 month after thrombolysis （4.7 ± 5.0 vs 25.1±15.1, P =0. 001 ） and higher reperfusion percentage （69%±32% vs 23% ± 54% ,P = 0. 044）. The total condition score of collateral flow was positively correlated with mRS at 3 months after treatment （ r = 0. 450, P = 0. 001 ）. Condusion： Acute ischemie stroke patients with good collateral flow after intravenous thrombolysis have a better outcome. The dynamic CTA can be used to evaluate the collateral flow and to predict clinical outcomes in patients with acute ischemic stroke after thrombolysis therapy.

关 键 词：动脉闭塞性疾病 药物疗法 卒中 药物疗法 急性病 血栓溶解疗法 血流动力学 血流速度 血管造影术 数字减影 血管造影术 体层摄影术 X线计算机 回顾性研究 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]