颅内大动脉狭窄性缺血性脑卒中患者不同时间点侧支循环的功能评价  

Functional evaluation of collateral circulation at different time points in patients with intracranial aortic stenosis and ischemic stroke

作　　者：闫海清[1] 王桂华 岳军艳[2] 孙玉莹 郭振方 陈杰[2] 张平[1] Yan Haiqing;Wang Guihua;Yue Junyan;Sun Yuying;Guo Zhenfang;Chen Jie;Zhang Ping(Department of Neurology,the First Hospital Affiliated to Xinxiang Medical University,Henan453100,China)

机构地区：[1]新乡医学院第一附属医院神经内科,河南453100 [2]新乡医学院第一附属医院影像科,河南453100 [3]新乡医学院第二附属医院神经内科

出　　处：《脑与神经疾病杂志》2020年第4期230-234,共5页Journal of Brain and Nervous Diseases

基　　金：河南省科技厅科技攻关计划项目(182102310529);河南省神经修复重点实验室开放课题资助项目(HNSJXF-2018-007)。

摘　　要：目的观察颅内大动脉狭窄性卒中患者在不同时间点脑血流灌注各参数的变化情况及探讨侧支循环的功能评价。方法收集2017年3月至2018年4月就诊于新乡医学院第一附属医院神经内科的45例颈内动脉颅内段或大脑中动脉中重度狭窄/闭塞的急性缺血性脑卒中(AIS)患者,所有患者均于发病7d内行CT灌注(CTP)检查,其中20例患者在3个月、15例患者在6个月、10例患者在12个月复查CTP。对不同随访时间点进行对比分析患侧脑血流量(CBF)参数、改良Rankin量表(mRS)评分及CTP各参数包括相对脑血流量(rCBF)、相对脑血容量(rCBV)、相对平均通过时间(rMTT)、相对达峰时间(rTTP)和相对延迟时间(rDelay)。结果3个月复查时有50%的患者CBF参数无明显改变,甚至有30%的患者CBF在进行性下降,仅有20%的患者CBF参数增加;6个月复查时,有47%的患者CBF无明显改变,有20%的CBF在进行性下降,有33%的CBF增加;12个月复查时,有40%的患者CBF无明显改变,有20%的CBF在进行性下降,而有40%的CBF增加。且在12个月时患者mRS评分有所下降(P<0.05)。3个月访视组CTP各参数表现为缺血半暗带区rCBV、rTTP、rDelay均较发病时下降,差异有统计学意义(P<0.01);6个月时CTP表现为缺血半暗带区rMTT、rTTP和rDelay均较发病时下降,差异有统计学意义(P<0.01);12个月时CTP表现为缺血半暗带区rCBF增多,r MTT、rTTP和rDelay均较发病时下降,差异有统计学意义(P<0.01)。结论CTP中CBF参数在不同时间点均有增加及下降的改变;不同时间点CTP各参数变化不同,TTP、Delay、MTT时间参数变化较早,CBF和CBV参数变化较晚,且在12个月复查CTP中CBF增加最明显,且患者预后较好,更能间接反应侧支循环建立及预后情况。Objective To observe the real changes of cerebral blood flow perfusion parameters in patients with intracranial aortic stenosis and to evaluate the functional evaluation of collateral circulation.Methods Included 45 patients with internal carotid artery intracranial segment or middle cerebral artery with severe stenosis/occlusion in the neurology department of the First Affiliated Hospital of Xinxiang Medical College from March 2017 to April 2018.In patients with acute ischemic stroke(AIS),all patients underwent CT perfusion(CTP)examination within 7 days after onset,of which 20 patients were at 3 months,15 patients were at 6 months,and 10 patients were reviewed for CTP at 12 months.Contrast analysis of different cerebral blood flow(CBF)parameters,mRS scores and CTP parameters including relative cerebral blood flow(rCBF),relative cerebral blood volume(rCBV),relative mean transit time(rMTT),relative Peak time(rTTP)and relative delay time(rDelay).Results At 3 months,50%of patients had no significant change in CBF parameters.Even 30%of patients had a progressive decline in CBF,and only 20%had an increase in CBF parameters.At 6 months,47%had CBF.There was no significant change,20%of CBF was progressively decreased,and 33%of CBF was increased.At 12 months of review,40%of patients had no significant change in CBF,and 20%had a progressive decrease in CBF.40%CBF increases.The patient's mRS score decreased at 12 months(P<0.05).The parameters of CTP in the 3-month visit group showed that the rCBV,rTTP and rDelay in the ischemic penumbra decreased compared with the onset,the difference was statistically significant(P<0.01);the CTP showed ischemia at 6 months.The rMTT,rTTP and rDelay in the penumbra zone decreased compared with the onset of the disease,and the difference was statistically significant(P<0.01).At 12 months,the CTP showed an increase in rCBF in the ischemic penumbra,and r MTT,rTTP and rDelay were compared.The incidence decreased,the difference was statistically significant(P<0.01).Conclusion The CBF parameters i

关 键 词：颅内大动脉狭窄 急性缺血性脑卒中 CT灌注成像 侧支循环 

分 类 号：R743.32[医药卫生—神经病学与精神病学]