弥散加权成像阿尔伯塔卒中项目早期CT评分预测急性期大脑中动脉供血区梗死患者的新发脑微出血  

Alberta stroke program early CT score on diffusion-weighted imaging predicts new cerebral microbleeds in patients with acute middle cerebral artery infarction

作　　者：刘艳[1,3] 丁云龙[1] 刘文鹏[1] 魏灿[1] 张艳荣[1] 刘丽[2] 陆云峰[1] 徐俊 

机构地区：[1]靖江市人民医院神经内科,214500 [2]靖江市人民医院磁共振室,214500 [3]扬州大学,225127 [4]苏北人民医院脑科中心/神经内科,扬州225001

出　　处：《国际脑血管病杂志》2015年第12期881-886,共6页International Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金（81471215;81271211）;江苏省社会发展重点项目（BE2015665）;江苏省自然科学基金（BK20151592）;社会发展重点病种规范化诊疗项目（BE2015715）

摘　　要：目的探讨弥散加权成像阿尔伯塔卒中项目早期cT评分（Alberta Stroke Program Eady CT Score on diffusion-weightedimaging，DWI-ASPECTS）对急性大脑中动脉供血区脑梗死患者新发脑微出血（cerebral microbleeds，CMBs）的预测价值。方法前瞻性纳入急性大脑中动脉供血区脑梗死患者，在入院48h内完成MRI检查并在发病10～14d时复查。采用磁敏感加权成像（susceptibility-weighted imaging，SWI）检测CMBs，采用DWI-ASPECTS评价梗死范围。结果共纳入82例急性大脑中动脉供血区脑梗死患者，男性55例，女性27例，年龄（71．7±8．9）岁，18例（22．0％）存在陈旧性CMBs，25例（30．5％）出现新发CMBs。与无新发CMBs组比较，新发CMBs组DWI-ASPECTSP评分[（3．20±1．73）分对（7．11±1．69）分；t=9．573，P〈0．001]较低，美国国立卫生研究院卒中量表评分[（16．20±4．06）分对（12．63±5．06）分；t=-3．111，P=0．003]较高，心房颤动患者（40．0％对15．8％；X2=5．722，P=0．017）较多，双重抗血小板治疗（O％对28．1％；P=0．002）的比例较低，大动脉粥样硬化性卒中（60．0％对29．8％；X^2=6．650，P：0．010）较多，心源性脑栓塞（36．0％对5．3％；P=0．001）较多，小动脉闭塞性卒中（0％对57．9％；P〈0．001）较少，其余指标无统计学差异。多变量logistic回归分析显示，在校正年龄、性别、饮酒、高血压、高脂血症、糖尿病、心房颤动、既往卒中或短暂性脑缺血发作史后，当DWI．ASPECTS评分〉5分时，新发CMBs风险下降86％（优势比0．14，95％可信区间0．17～0．48；P〈0．001）。受试者工作特征曲线分析显示，ASPECTS评分≤5分预测新发CMBs的敏感性为87．7％，特异性为88．3％，曲线下面积为0．940。结论DWI-ASPECTS可有效预测急性大脑中动脉供血区脑梗死患者新发CMBs风险。Objective To investigate the predictive value of Alberta stroke program early CT score on diffusion-weighted imaging （DWI-ASPECTS） for predicting new cerebral microbleeds （CMI3s） in patients with acute middle cerebral artery infarction. Methods The patients with acute middle cerebra artery infarction were enrolled prospectively. MRI examinations were completed within 48 h on admission and they were examined again at 10 to 14 d after onset. Suscept^ility-weighted imaging （SWI） was use to detect CMBs. DWI-ASPECTS was used to assess the infarction extent.Results A total of 82 patients with acute middle cerebra artery infarction were enrolled, including 27 females and 55 females. Their ages were 71.7 ± 8. 9 years. Eighteen patients （22. 0%） had old CMBs, 25 （30. 5%） had new CMBs, 57 （69.5%） did not have new CMBs. Compared with the non-new CMB group, DWI-SPECTS （3.20 ± 1.73 vs. 7.11 ± 1.69; t =9. 573, P 〈0. 001） was lower, NIHSS scores （16.20 ± 4. 06 vs. 12.63 ± 5.06; t = 3. 11 l, P = 0. 003） were higher, there were more patients with atrial fibrillation （40. 0% vs. 15. 80%;X^2=5. 722, P=O. 017）, proportion of intensive antiplatelet therapy （0% vs. 28.1% ; P =0. 002） was lower, there were more large artery atherosclerosis type （60. 0% vs. 29. 8%; X^2 = 6. 650, P= O. 010）, more cardiogenic cerebral embolism type （36.0% vs. 5.3% ; P =0. 001）, and less small artery occlusion type （0% vs. 57.9% ; P 〈 0. 001） in the new CMB group, and there were no statistical differences in the other indexes. Multivariate logistic regression analysis showed that after adjusting age, sex, alcohol, histories of hypertension, hyperlipidemia, diabetes, atrial fibrillation and previous stroke or transient ischemic attack history, the higher the DWI-ASPECT scores （ 〉 5）, the risk of new CMBs would decrease 86% （odds ratio 0. 14, 95% confidence interval 0. 17- 0. 48; P〈0. 001）. Receiver operating characteristic curve analysis showed that the sensitivity of prediction of DWI

关 键 词：脑梗死 微出血 疾病严重程度指数 弥散磁共振成像 磁共振成像 危险因素 危险性评估 

分 类 号：R743.3[医药卫生—神经病学与精神病学]