脑实质强化程度预测急性前循环大血管闭塞性脑梗死血管内治疗后出血转化风险研究  

Brain Parenchymal Enhancement Predicts Hemorrhagic Transformation after Endovascular Treatment in Acute Cerebral Infarction with Anterior Circulation Large Vessel Occlusion

作　　者：郑亚利 于瑞晓 于永鹏[1,3] 白家赫 ZHENG Ya-Li;YU Rui-Xiao;YU Yong-Peng;BAI Jia-He(Department of Neurology,Weihai Central Hospital Affiliated to Qingdao University,Weihai,Shandong Province,Weihai 264400,China;Department of Neurology,the People's Hospital of Lanling,Linyi,Shandong Province,Linyi 276000,China;Department of Neurology,Weihai Central Hospital Affiliated to Weifang Medical college,Weihai 264400,China)

机构地区：[1]青岛大学附属威海市中心医院神经内科,威海264400 [2]临沂市兰陵县人民医院神经内科 [3]潍坊医学院附属威海市中心医院神经内科

出　　处：《中国卒中杂志》2021年第2期181-186,共6页Chinese Journal of Stroke

基　　金：国家自然科学基金项目(81400957)。

摘　　要：目的评估急性前循环大血管闭塞性脑梗死血管内治疗术后CT平扫脑实质强化程度预测出血转化(hemorrhagic transformation,HT)的临床价值。方法连续收集2017年1月-2019年9月在威海市中心医院及兰陵县人民医院卒中中心接受血管内治疗的急性前循环大血管闭塞性脑梗死患者的影像学资料。根据术后即刻头颅CT显示的造影剂外渗情况评估脑实质强化程度,分为脑实质无或轻度强化组和中重度强化组,术后24~36 h行头颅CT评估HT情况。比较两组HT发生率,探讨血管内治疗术后即刻CT平扫脑实质强化程度与HT的关系。另外,根据术前CTP结果,比较中重度强化组术前梗死侧和健侧表面通透性(permeability surface,PS)的差异,并比较两组梗死侧相对PS(relative PS,rPS)的差异。结果共纳入30例接受血管内治疗的急性脑梗死患者,术后CT显示脑实质中重度强化组14例,发生HT者7例(50.0%);无或轻度强化组16例,发生HT者1例(6.3%),差异有统计学意义(P=0.04)。中重度强化组患者梗死侧PS值高于健侧[2.99(2.90~3.10)mL/(100 g·min)vs 2.00(1.97~2.33)mL/(100 g·min),P=0.01],中重度强化组梗死侧rPS高于无或轻度强化组(1.44±0.28 vs 1.10±0.07,P=0.01)。结论急性前循环大血管闭塞性脑梗死血管内治疗术后即刻CT显示的脑实质强化程度可能是预测HT的一种直观有效的影像学标志物。Objective To evaluate the clinical value of cerebral parenchymal enhancement in predicting hemorrhagic transformation(HT)after endovascular therapy in acute cerebral infarction with anterior circulation large vessel occlusion.Methods A retrospective analysis was performed for the clinical data of the patients with anterior circulation large vessel occlusion who underwent endovascular treatment in Stroke Center of Weihai Central Hospital and the People's Hospital of Lanling from January 2017 to September 2019.Brain parenchymal enhancement was assessed by contrast extravasation on head CT scan immediately after endovascular therapy,which reflects blood brain barrier damage.According to the enhancement degree,all the patients were divided into mild and no enhancement group and moderate and severe enhancement group.All the patients underwent head CT scan at 24-36 hours after surgery to evaluate intracranial hemorrhage.The relationship between brain parenchymal enhancement and HT was analyzed.Based on preoperative CTP,the difference in permeability surface(PS)between the lesion side and health side in moderate and severe enhancement group and the relative PS(rPS)between mild and no enhancement group and moderate and severe enhancement group were compared.Results A total of 30 patients were included.7(50.0%)of 14 patients in moderate and severe enhancement group developed HT,and 1(6.3%)of 16 patients in mild and no enhancement group developed HT(P=0.04).The PS of the lesion side was higher than that of health side in moderate and severe enhancement group[2.99(2.90-3.10)mL/(100 g·min)vs 2.00(1.97-2.33)mL/(100 g·min),P=0.01],and the rPS in moderate and severe enhancement group was higher than that in mild and no enhancement group(1.44±0.28 vs 1.10±0.07,P=0.01),both the difference were statistically significant.Conclusions Cerebral parenchymal enhancement signal on CT immediately after endovascular therapy can be a valuable imaging biomarker for predicting HT in acute cerebral infarction with anterior circulation larg

关 键 词：脑梗死 出血转化 血脑屏障 血管内治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]