急性脑梗死CT灌注成像分期与大脑中动脉狭窄程度及临床预后的相关性研究  

Correlation study of CT Perfusion imaging staging with middle cerebral artery stenosis and clinical prognosis in patients with acute cerebral infarction.

作　　者：付秀鑫 郑艳华[1] 庄甲军 董晓燕 王琦[1] 李剑平[1] FU Xiu-xin;ZHENG Yan-hua;ZHUANG Jia-jun(Department of Neurology,Weifang People's Hospital Affiliated to Weifang Medical College,Weifang Shandong 261021,China.)

机构地区：[1]潍坊医学院附属潍坊市人民医院神经内科,山东潍坊261021

出　　处：《临床和实验医学杂志》2021年第9期916-919,共4页Journal of Clinical and Experimental Medicine

基　　金：山东省卫生厅基金资助项目(编号:SW-2012B036);潍坊市科技发展计划项目基金项目(编号:2019YX038)。

摘　　要：目的探讨颅脑CT灌注成像分期与大脑中动脉狭窄程度及临床预后的相关性。方法前瞻性纳入2018年5月至2020年4月在潍坊医学院附属潍坊市人民医院神经内科诊断为急性前循环脑梗死的患者165例,发病时间6 h至3 d。行颅脑CT灌注成像(CTP)及同步CT血管造影(CTA),记录达峰时间(TTP)、平均通过时间(MTT)、脑血容积(CBV)、脑血流量(CBF)等灌注参数。与健侧对比,将脑血流灌注异常区分为4期:Ⅰ期:TTP延长,MTT、CBF、CBV正常;Ⅱ期:TTP和MTT延长,CBF正常,CBV正常或轻度升高;Ⅲ期:TTP和MTT延长,CBF下降,CBV基本正常或轻度下降;Ⅳ期:TTP和MTT延长,CBF和CBV下降。记录入院时、治疗14 d时美国国立卫生研究院卒中量表(NIHSS)和改良Rankin量表(mRS)评分和出院90 d时mRS评分。根据病灶侧大脑中动脉M1段狭窄程度分为轻度狭窄组(狭窄率<50%)、中重度狭窄组(狭窄率50%~99%)和闭塞组。观察脑梗死急性期患侧大脑中动脉狭窄程度与脑血流灌注异常分期的相关性,以及脑血流灌注异常分期与临床预后的相关性。结果①共纳入165例患者,梗死核心区周围存在脑血流灌注异常者142例,其中:Ⅰ期29例(20.4%)、Ⅱ期47例(33.1%)、Ⅲ期41例(28.9%)、Ⅳ期25例(17.6%);病灶侧大脑中动脉M1段轻度狭窄42例(25.6%),中重度狭窄72例(43.6%)、闭塞51例(30.9%);②大脑中动脉不同狭窄程度与脑血流灌注异常分期之间存在相关性(P<0.05);③脑血流灌注异常分期与临床转归及短期预后之间存在相关性,Ⅳ期患者治疗14 d NIHSS评分及出院90 d mRS评分明显高于Ⅰ、Ⅱ、Ⅲ期患者,差异有统计学意义(P<0.05)。结论大脑中动脉不同狭窄程度可影响梗死核心区周围脑血流灌注;脑血流灌注异常Ⅳ期患者与较差的临床转归及90 d预后不良相关。脑血流灌注分期可反映脑梗死后侧支循环形成和建立情况,对临床预后有预测价值,是良好预后的重要预测因素,对急性脑梗Objective To investigate the correlation among CT perfusion imaging staging and the degree of middle cerebral artery stenosis and clinical prognosis.Methods From May 2018 to April 2020,165 patients with acute anterior circulation cerebral infarction diagnosed in the Department of Neurology,Weifang People's Hospital Affiliated to Weifang Medical College were enrolled in this prospective observational study.The onset time was 6 h to 3 d.CT perfusion imaging(CTP)and synchronous CT angiography(CTA)were performed in these patients.The perfusion parameters such as time to peak(TTP),mean transit time(MTT),cerebral blood volume(CBV),and cerebral blood flow(CBF)were recorded.Compared with the contralateral,the abnormal area of cerebral blood flow perfusion was divided into four stages.In stage I,TTP was prolonged and MTT,CBF and CBV were normal;In stage II:TTP and MTT were prolonged,CBF was normal,CBV was normal or slightly increased;In stage III:TTP and MTT were prolonged,CBF was normal,CBV was basically normal or slightly decreased;In stage IV:TTP and MTT were prolonged,CBF and CBV were decreased.The National Institutes of Health Stroke Scale(NIHSS)scores at admission and 14 days after treatment and the modified Rankin scale(mRS)score at 90 days after discharge were record.According to the stenosis degree of M1 segment of MCA,the patients were divided into mild stenosis group(stenosis rate<50%),moderate severe stenosis group(stenosis rate 50%-99%)and occlusion group.To observe the correlation between the severity of middle cerebral artery stenosis and the abnormal stage of cerebral blood flow in patients with acute cerebral infarction,and the correlation between abnormal cerebral perfusion and prognosis.Results①A total of 165 patients were enrolled.142 patients had abnormal cerebral blood perfusion around the infarct core area,including 29 cases(20.4%)in stage I,47 cases(33.1%)in stage II,41 cases(28.9%)in stage III and 25 cases(17.6%)in stage IV;42 cases(25.6%)were mild stenosis in M1 segment of middle cerebral arter

关 键 词：急性脑梗死 CT灌注成像 大脑中动脉狭窄 

分 类 号：R743.33[医药卫生—神经病学与精神病学]