前循环缺血性脑卒中血管内治疗后平板CT高密度征与出血转化的相关性研究  

Correlation between flat-panel CT high-density sign and hemorrhagic transformation in patients with anterior circulation ischemic stroke after endovascular treatment

作　　者：孙松堂 朱良付[2] 王丽娜 吴立恒[2] 周志龙[2] 管民[2] 贺迎坤[2] 何艳艳[2] 邢莹 周腾飞 李天晓[2] Sun Songtang;Zhu Liangfu;Wang Lina;Wu Liheng;Zhou Zhilong;Guan Min;He Yingkun;He Yayan;Xing Ying;Zhou Tengfei;Li Tianxiao(Xinxiang Medical College,Xinxiang 453003,China;Department of Cerebrovascular Disease,He'nan Provincial People's Hospital,Zhengzhou 450000,China)

机构地区：[1]新乡医学院,新乡453003 [2]河南省人民医院脑血管科,郑州450000

出　　处：《中华神经医学杂志》2020年第8期763-769,共7页Chinese Journal of Neuromedicine

基　　金：河南省自然科学基金(182300410315);河南卫生健康科技英才海外研修工程(HWYX2019130)。

摘　　要：目的探讨急性前循环大血管闭塞性缺血性脑卒中血管内治疗后平板CT高密度征的特点及其与出血转化的相关性。方法对河南省人民医院脑血管科自2018年3月至2019年6月收治的78例予血管内治疗后行平板CT检查的急性前循环大血管闭塞性缺f血性脑卒中患者,分别依据其是否存在局部平板CT高密度征及是否发生出血转化进行分组,对比高密度征组与非高密度征组、出血转化组与非出血转化组患者间临床资料的差异,并分析平板CT高密度征与出血转化的关联性;进-一步分析高密度征组患者平板CT高密度征的形态特点及分布.并采用单因素分析及多因素Logistic回归分析筛选出影响平板CT高密度征患者术后出血转化的危险因素。结果(1)血管内治疗后平板CT高密度征的发生率为41.0%(32/78)。与非高密度征组相比.高密度征组患者出血转化的发生率明显更高(6.5%vs.53.1%),3个月改良Rankin量表(mRS)评分明显更高[2.0(1.0,3.0)分vs.3.9(3.0,5.3)分],差异均有统计学意义(P<0.05)。(2)血管内治疗后出血转化的发生率为25.6%(20/78)。与非出血转化组相比,出血转化组患者平板CT高密度征的发生率更高(31%vs.70%),差异有统计学意义(P<0.05);多因索Logistic回归分析显示平板CT高密度征是血管内治疗后出血转化的独立危险因素(OR=1.823.95%CI:1.125-2.358.P=0.000)。(3)脑皮质及皮质下、基底节区、蛛网膜下腔中平板CT高密度征的发生率分别为12.5%(4/32).40.6%(13/32).21.9%(7/32).出血转化发生率分别为75%(3/4).53.8%(7/13)和57.1%(4/7),3个月mRS评分平均分别为4.5.3.0和4.0分;另有8例(25%)患者出现血管内平板CT高密度征,其出血转化发生率高达87.5%(7/8),3个月mRS评分均>4分。(4)多因素Logistic回归分析显示血管开通时间≤6h是平板CT高密度征患者出血转化的保护因素(OR=0.687,95%Cl:0.193~0.936,P=0.044)。结论急性前循环大血管闭塞性缺血性脑卒中血管内�Objective To explore the characteristics of high-density sign of flat-panel CT(FDCT)after endovascular treatment in patients with acute ischemic stroke(AIS)in the anterior circulation of large vessels and their relation with hemorrhagic transformation.Methods Seventyeight patients with AIS in the anterior circulation of large vessels accepted endovascular treatment in our hospital from March 2018 to June 2019 were chosen in our study.All patients underwent FDCT,and they were grouped according to the presence of local high-density sign and occurrence of hemorrthagic transformation.The baseline and clinical data of patients from high-density sign group and non-high-density sign group,and from hemorrhagic transformation group and non-hemorrhagic transformation group were compared and analyzed.The correlation between high-density sign and hemorrhagic transformation was analyzed.The morphological characteristies and distribution of FDCT high-density sign in patients from high-density sign group were analyzed,and univariate and multivariate Logistic regression analyses were used to screen the influencing factors for post-operative hemorrhagic transformation in patients from the high-density sign group.Results(1)The incidence of high-density sign in these patients after endov ascular treatment was 41.0%(32/78);as compared with patients in the non-high-density sign group,patients in the high-density sign group had significantly higher rate of hemorrhagic transformation(6.5%v8.53.1%,P<0.05)and significantly higher 3-month modifed Rankin scale(mRS)scores(2.0[1.0,3.0]vs.3.9[3.0,5.3],P<0.05).(2)The incidence of hemorrhagic transformation after endovascular treatment was 25.6%(20/78);as compared with those in the non-hemorrhagic transformation group,patients in the hemorrhage transformation group had statistically higher incidence of high-density sign in FDCT(31%vs.70%,P<0.05);multivariate Logistic regression analysis showed that FDCT high density sign was an independent risk factor for hemorrhage transformation after endovas

关 键 词：缺血性脑卒中 平板CT 高密度征 出血转化 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]