基于低灌注强度比值探讨急性脑卒中首次成功再灌注对预后的影响  

To investigate the impact of first pass reperfusion on functional outcome of acute stroke based on hypoperfusion intensity ratio

作　　者：吴含[1] 郭群[1] 靳明旭[1] 彭明洋 殷信道[1] 高伟[1] WU Han;GUO Qun;JIN Mingxu;PENG Mingyang;YIN Xindao;GAO Wei(Department of Radiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 21006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,南京210006

出　　处：《磁共振成像》2021年第3期34-38,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：江苏省科技发展计划项目(编号:BE2017614);南京市卫计委医药卫生科研项目(编号:YKK18101)。

摘　　要：目的探讨不同侧支循环的急性卒中患者血管内机械取栓(endovascular thrombectomy,EVT)治疗后首次成功再灌注(first pass reperfusion,FPR)对预后的影响。材料与方法回顾性纳入急性脑卒中患者180例,所有患者均于入院后行磁共振灌注成像及EVT治疗。应用低灌注强度比值(hypoperfusion intensity ratio,HIR)评估侧支循环,HIR<0.4为侧支循环丰富,HIR≥0.4为侧支循环不丰富。FPR定义为首次取栓时即达到改良脑梗死溶栓血流分级(modified thrombolysis in cerebral infarction,mTICI)2b-3级。统计学方法分别分析不同侧支循环卒中患者EVT治疗后FPR对预后的影响。结果HIR≥0.4卒中患者72例,与非FPR组(30例)相比,FPR组(42例)患者3个月致死率(11.90%与33.33%)较低,3个月预后良好率(59.52%与33.33%)较高,两组间比较差异有明显统计学意义(t=4.872,P=0.039;t=4.805,P=0.034)。HIR<0.4卒中患者108例,FPR组(73例)与非FPR组(35例)间3个月致死率、3个月预后良好率无明显统计学差异(P>0.05)。Logistic回归分析显示FPR为预测急性脑卒中HIR≥0.4患者良好预后的独立预测因子(OR=2.281,95%CI:1.419~5.286;P=0.018),而FPR在预测急性脑卒中HIR<0.4患者良好预后中无明显统计学意义(OR=1.693,95%CI:0.596~4.798;P=0.319)。结论FPR对急性脑卒中患者预后的影响依赖于侧支循环,当患者侧支循环不丰富时(HIR≥0.4)FPR对卒中预后的影响更显著。Objects:To investigate the impact of first pass reperfusion(FPR)on functional outcome of acute stroke with different collateral circulation after endovascular thrombectomy(EVT).Materials and Methods:A total of 180 acute stroke patients in our hospital were enrolled retrospectively.All patients underwent MR perfusion imaging and EVT therapy.Hypoperfusion intensity ratio(HIR)was used to evaluate collateral circulation.Good collateral circulation was defined as HIR<0.4 and poor collateral circulation was defined as HIR≥0.4.FPR was defined as achieving modified Thrombolysis in Cerebral Infarction(mTICI)2 b-3 after a single pass of the device.Statistical methods were performed to analyze the impact of FPR on the outcome in acute stroke with different collateral circulation after EVT therapy.Results:For patients with HIR≥0.4(n=72),compared with non-FPR group(n=30),the mortality rate at 3 months(11.90%vs.33.33%)was lower and good functional outcome at 3 months(59.52%vs.33.33%)was higher in FPR group(n=42).For patients with HIR<0.4(n=108),the mortality rate at 3 months and good functional outcome at 3 months had no significant differences between two group(P>0.05).Logistic regression analysis showed that FPR was an independent predictor of good functional outcome in acute stroke patients with HIR≥0.4(OR=2.281,95%CI:1.419—5.286;P=0.018).While FPR had no significant difference in predicting the good functional outcome in acute stroke patients with HIR<0.4(OR=1.693,95%CI:0.596-4.798;P=0.319).Conclusions:The effect of FPR on functional outcome is highly dependent on collateral circulation.When the collateral circulation is poor(HIR≥0.4),the effect of FPR on functional outcome is more prominent.

关 键 词：卒中 磁共振成像 灌注加权成像 血管内机械取栓治疗 预后 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.33[医药卫生—诊断学]