PCMRI基底动脉血流动力学参数检测联合血清PLGF、LDH对子痫孕妇合并RPLS诊断价值  

The diagnostic value of PCMRI basilar artery hemodynamic parameters in combination with serum PLGF and LDH in diagnosis of reversible posterior leukoencephalopathy syndrome in pregnant women with eclampsia

作　　者：张婉[1] 王江峰[2] 刘辉[1] 许保刚[3] 杨永康[4] ZHANG Wan;WANG Jiang-feng;LIU Hui;XIU Bao-gang;YANG Yong-kang(Department of CT Room, Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi Province, Xianyang 712000,China;Department of Neurosurgery, Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi Province, Xianyang 712000, China;Department of MRI Room, Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi Province, Xianyang 712000,China;Department of Obstetrics and Gynecology, Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shaanxi Province, Xianyang 712000,China)

机构地区：[1]陕西中医药大学第二附属医院CT室,陕西咸阳712000 [2]陕西中医药大学第二附属医院神经外科,陕西咸阳712000 [3]陕西中医药大学第二附属医院MRI室,陕西咸阳712000 [4]陕西中医药大学第二附属医院妇产科,陕西咸阳712000

出　　处：《河北医科大学学报》2020年第6期694-699,共6页Journal of Hebei Medical University

摘　　要：目的探讨相位对比磁共振成像((phase contrast magnetic resonance imaging,PCMRI)基底动脉血流动力学参数检测联合血清胎盘生长因子(placental growth factor,PLGF)、乳酸脱氢酶(Lactic dehydrogenase,LDH)对子痫孕妇合并可逆性后部白质脑病综合征(reversible posterior leukoencephalopathy syndrome,RPLS)诊断价值。方法选择子痫前期(preeclampsia,PE)患者110例为研究对象,所有患者均接受常规头颅MR扫描,依据常规MRI检查结果将患者分为MRI正常组和RPLS组。收集患者的临床资料及实验室检查结果,同时采用PCMRI技术测量基底动脉血流动力学参数,采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定2组血清PLGF、LDH水平,比较实验室检查结果、基底动脉血流动力学参数、血清PLGF、LDH值等指标,并通过绘制ROC曲线确定基底动脉血流动力学参数联合血清PLGF、LDH对PE患者合并RPLS的诊断价值。结果MRI正常组未见明显病灶,RPLS组常规MRI头颅扫描结果T1WI为稍低信号或等信号,T2WI及FLAIR呈高信号,DWI序列表现为稍低信号或等信号。RPLS组基底动脉(basilar artery,BA)的平均流量(mean flow,MF)、平均流速(mean velocity,MV)及血管断面面积均明显高于MRI正常组,而血流阻力指数(resistant index,RI)明显低于MRI正常组(P<0.01)。RPLS组血清PLGF水平明显低于MRI正常组,血清LDH明显高于MRI正常组(P<0.01)。Spearman相关性分析结果显示,BAMV、MF及血清LDH与SBE评分显著正相关(r=0.71、0.67、0.68,P<0.01),RI与SBE评分呈显著负相关(r=-0.65,P<0.01)。PCMRI血流参数联合血管内皮损伤标志物诊断RPLS的曲线下面积为0.897(95%CI:0.853~0.941),其对应的敏感度和特异度分别为93.0%、100.0%,明显优于各指标单独检测。结论RPLS的BA血流参数及血清PLGF、LDH的变化与疾病的发生发展和脑水肿严重程度密切相关,影像学检查联合血清指标检测能够提高疾病诊断特异度。Objective To investigate the diagnostic value of phase contrast magnetic resonance imaging(PCMRI)combined with serum placental growth factor(PlGF)and lactate dehydrogenase(LDH)on the reversible posterior leukoencephalopathy syndrome(RPLS).Methods A total of 110 patients with preeclampsia(PE)in our hospital were selected as the study objects.All patients were scanned with conventional MR according to the results of conventional MRI,the patients were divided into two groups:normal group and RPLS group.At the same time,PCMRI was used to measure the hemodynamic parameters of basilar artery,and enzyme-linked immunosorbent assay(ELISA)was used,The level of PLGF and LDH in serum of the two groups were measured by ELISA,and the differences of laboratory test results,parameters of basilar artery hemodynamics,values of PLGF and LDH in serum were compared.The diagnostic value of basilar artery hemodynamics parameters combined with serum PlGF and LDH in PE patients with RPLS was determined by drawing ROC curve.Results No obvious lesions were found in the normal group.The results of conventional MRI in RPLS group showed that T1WI was slightly low signal or equal signal,T2WI and flair were high signal,and DWI sequence was slightly low signal or equal signal.The MF,MV and vascular cross-sectional area of BA in RPLS group were significantly higher than those in MRI group,while RI was significantly lower than that in MRI group(P<0.01).In RPLS group,PLGF water was significantly lower than that in MRI normal group,and LDH was significantly higher than that in MRI normal group(P<0.01).Spearman correlation analysis showed that BAMV,MF and LDH were positively correlated with SBE(r=0.71,0.67,0.68,P<0.01),RI was negatively correlated with SBE score(r=-0.65,P<0.01)。The area under the curve of pcmri blood flow parameters combined with vascular endothelial damage markers in the diagnosis of RPLS was zero point eight nine seven(95%CI:0.853-0.941)The corresponding sensitivity and specificity were 93.0%,100.0%,which was obviously better tha

关 键 词：子痫 后部白质脑病综合征 相位对比磁共振成像 

分 类 号：R714.245[医药卫生—妇产科学]