侧支循环评分及磁共振3D-ASL技术对急性前循环大血管闭塞患者再灌注治疗预后的评估价值  

Collateral circulation score and 3D arterial spin labeling magnetic resonance in evaluating the prognosis of patients with acute anterior circulation occlusion after thrombectomy

作　　者：陈峰[1] 王洁[2] 甘解华[1] 樊如梦 卢苗青[1] 陈勇[1] CHEN Feng;WANG Jie;GAN Jiehua;FAN Rumeng;LU Miaoqing;CHEN Yong(Department of Neurology,Ningbo Medical Center Li Huili Hospital,Ningbo 315040,China)

机构地区：[1]宁波市医疗中心李惠利医院神经内科,315040 [2]宁波市医疗中心李惠利医院影像科,315040

出　　处：《浙江医学》2021年第10期1091-1095,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2018KY706)。

摘　　要：目的探讨侧支循环评分及磁共振三维动脉自旋标记(3D-ASL)技术对急性前循环大血管闭塞患者再灌注治疗预后的评估价值。方法选择2017年6月至2019年12月在宁波市医疗中心李惠利医院接受再灌注治疗的患者26例,根据取栓术后1周的NIHSS评分将患者分为预后良好组12例及预后不良组14例,术中利用数字减影血管造影(DSA)对侧支循环进行评分;术后行MRI检查,包括T1WI、T2WI、FLAIR、DWI、3D-ASL等序列,通过软件后处理得到健侧、患侧的脑血流量(CBF)值并计算相对CBF值;比较两组患者的性别、年龄、高血压、糖尿病、房颤、吸烟、术前NIHSS评分、侧支循环评分、CBF值的差异,将结果进行二元logistic分析,得出影响患者预后的独立影响因素,采用ROC曲线分析侧支循环评分预测患者预后的最佳阈值。结果预后良好组患者年龄低于预后不良组,侧支循环评分、CBF_(患侧)、CBF_(相对值)均高于预后不良组,差异均有统计学意义(均P<0.05)。两组患者高血压、糖尿病、房颤、吸烟、术前NIHSS评分比较,差异均无统计学意义(均P>0.05);二元logistic回归分析显示侧支循环评分是患者预后的独立影响因素(OR=29.241,95%CI:1.070~799.231,均P<0.05),年龄、CBF_(患侧)、CBF_(相对值)是非独立影响因素,OR=0.752、1.081、0.043,均P>0.05)。ROC曲线提示侧支循环评分>2.5分是预测患者术后恢复良好的最佳阈值,灵敏度为0.667,特异度为0.857。结论侧支循环评分及3D-ASL能够较好评估急性前循环大血管闭塞患者再灌注治疗后的预后情况。Objective To assess the application of collateral circulation score and 3D arterial spin labeling(3D-ASL)magnetic resonance in the evaluation of prognosis in patients with acute anterior circulation occlusion after thrombectomy.Methods Twenty-six patients who underwent thrombectomy in Ningbo Medical Center Li Huili Hospital from June 2017 to December 2019 were enrolled in the study.According to the NIHSS score one week after thrombectomy,the patients were divided into good prognosis group(n=12)and poor prognosis group(n=14).DSA was used to evaluate the collateral circulation score during operation,and MRI was performed after operation,including T1WI,T2WI,FLAIR,DWI,and 3D-ASL sequences.The cerebral blood flow(CBF)values of healthy side and affected side were obtained by software,and the relative CBF values were calculated.The gender,age,hypertension,diabetes,atrial fibrillation,smoking,preoperative NIHSS score,collateral circulation score and CBF between the two groups were compared,and the results were analyzed by binary logistic analysis to obtain the independent factors influencing the prognosis of patients.The collateral circulation score for predicting the prognosis of patients was analyzed by receiver operating characteristic curve(ROC).Results The age of patients with good prognosis was lower than that of patients with poor prognosis(63.50±10.59 years vs.70.43±6.08 years,P<0.05).The collateral circulation score,CBF affected side and CBF relative value of patients with good prognosis[3.00(2.00,3.75)points,(74.46±21.68)ml/100g·min,(1.78±0.45)]were higher than those of patients with poor prognosis[2.00(1.00,2.00)points,(53.47±14.16)ml/100g·min,(1.37±0.26),all P<0.05].There were no significant differences in hypertension,diabetes,atrial fibrillation,smoking,preoperative NIHSS score between the good prognosis group and the poor prognosis group[8(66.67%)vs.10(71.43%);2(16.67%)vs.3(21.43%);4(33.33%)vs.6(42.86%);3(25.00%)vs.5(35.71%);14.50(13.00,16.75)points vs.15.50(11.75,17.25)points,all P>0.05].Binary lo

关 键 词：3D-ASL 动脉取栓术 再灌注 脑血流量 侧支循环评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]