微血管表面通透性预测急性缺血性脑梗死自发性出血性转化  

Predictive effect of microvascular permeability surface on spontaneous hemorrhagic transformation in patients with acute ischemic cerebral infarction

作　　者：江岷芮[1] 童海鹏[1] 邓洋 冉启胜[1] 张伟国[1] JIANG Minrui;TONG Haipeng;DENG Yang;RAN Qisheng;ZHANG Weiguo(Department of Radiology,Institute of Surgery Research,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院野战外科研究所放射科,重庆400042

出　　处：《中国介入影像与治疗学》2019年第5期290-293,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨微血管表面通透性(PS)对急性缺血性脑梗死患者自发性出血性转化(HT)的预测效果。方法回顾性分析43例未接受动脉溶栓或静脉溶栓的急性缺血性脑梗死患者的CT灌注成像(CTPI)资料,根据脑梗死发病2周内CT或MR检查显示是否发生HT将其分为HT组(n=20)和对照组(n=23)。采用Mann-Whitney U检验比较HT组患侧与对侧间、HT组患侧与对照组患侧间CTPI参数[PS、脑血容量(CBV)及脑血流量(CBF)]的差异。绘制ROC曲线,评价PS值预测自发性HT的效能。结果与对侧比较,HT组患侧PS值(Z=-5.410,P<0.001)及CBV值(Z=-3.517,P<0.001)均明显升高,CBF值明显降低(Z=-2.245,P=0.024)。与对照组患侧比较,HT组患侧PS值(Z=-5.065,P<0.001)及CBV值(Z=-3.458,P=0.001)均明显升高,CBF值差异无统计学意义(Z=-1.729,P=0.084)。ROC曲线分析显示,以PS值0.032 4 ml/(100 ml·min)为临界值,诊断急性缺血性脑梗死患者自发性HT的AUC为0.952,敏感度、特异度及准确率分别为90.00%、82.60%及86.05%。结论 PS值可用于预测急性缺血性脑梗死患者自发性HT,有助于临床合理制定治疗方案。Objective To explore the predictive effect of microvascular permeability surface (PS) on spontaneous hemorrhagic transformation (HT) in acute ischemic stroke patients.Methods A retrospective analysis was performed on 43 patients with acute ischemic stroke who underwent CT perfusion imaging (CTPI).Neither arterial thrombolysis nor intravenous thrombolysis was carried out in these patients.The patients were divided into HT group ( n =20) and control group ( n =23) according to whether HT occurred within 2 weeks after the onset of stroke detected with CT or MRI.Mann-whitney U test was used to compare the differences of CTPI parameters,including PS,cerebral blood volume (CBV) and cerebral blood flow (CBF) between the affected and contralateral areas in HT group,and CTPI parameters of the affected area were also compared between HT and control groups.ROC curve was used to analyze the efficiency of PS value to predict HT.Results In HT group,PS ( Z =-5.410,P <0.001) and CBV ( Z =-3.517,P <0.001) of the affected area were higher than those of contralateral area,while CBF ( Z =-2.245,P =0.024) of the affected area was lower than that of contralateral area.PS ( Z =-5.065,P <0.001) and CBV ( Z =-3.458,P =0.001) of the affected area in HT group were higher than those in control group,while there was no statistical difference of CBF ( Z =-1.729,P =0.084) of the affected area between HT and control group.ROC analysis showed that the AUC was 0.952 for predicting HT in acute ischemic stroke patients with the threshold of PS as 0.032 4 ml/(100 ml·min).The sensitivity,specificity and accuracy was 90.00%,82.60% and 86.05%,respectively.Conclusion PS value can be used to predict HT in patients with acute ischemic stroke,therefore being helpful to appropriate treatments in clinic.

关 键 词：微血管表面通透性 出血性转化 体层摄影术 X线计算机 灌注成像 脑梗死 

分 类 号：R651.1[医药卫生—外科学] R814.42[医药卫生—临床医学]