脑灌注成像预测机械取栓后急性缺血性脑卒中患者出血转化风险的价值  

Value of cerebral perfusion-weighted imaging in predicting the risk of hemorrhagic transformation in patients with acute ischemic stroke after mechanical thrombectomy

作　　者：张建雷 张睿 潘菲 郝新霞 ZHANG Jian-lei;ZHANG Rui;PAN Fei;HAO Xin-xia(Department of Interventional Cerebrovascular Disease,Xinjiang Cardiovascular and Cerebrovascular Disease Hospitdl,Urumqi 830000,China)

机构地区：[1]新疆心脑血管病医院脑血管病介入科,新疆乌鲁木齐830000

出　　处：《中国临床医学影像杂志》2021年第11期761-765,共5页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨脑灌注成像预测机械取栓后急性大血管闭塞性缺血性卒中(AIS-LVO)患者出血转化(HT)风险的价值。方法:选择2018年6月—2020年6月本院接受机械取栓的AIS-LVO患者102例,所有患者临床资料完善。治疗前均行健侧和患侧脑CT灌注扫描,获取患者表面通透性(PS)、脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、对比剂峰值时间(TTP),绘制ROC曲线获得各指标截断值和预测价值,卡方检验、多因素回归分析其与HT发生的关系。结果:102例AIS-LVO患者机械取栓后共发生39例HT(38.24%),症状性HT有19例、无症状性HT有20例。出血组年龄、NIHSS评分高于未出血组(P<0.05);治疗前出血组rPS、rMTT、rTTP高于未出血组;治疗后出血组r PS、rMTT、rTTP高于未出血组(P<0.05),rCBF、r CBV低于未出血组;出血组|r PS|、|rCBF|、|rCBV|、|rMTT|、|rTTP|均大于未出血组;差异均有统计学意义(P<0.05)。|rPS|、|rCBF|、|rCBV|、|rMTT|、|rTTP|是HT发生的独立影响因素(P<0.05),且可预测出血的发生,预测模型拟合度大小依次为联合、MTT、PS、CBF、CBV、TTP,AUC均>0.7。结论:治疗前的脑灌注成像指标PS、CBF、CBV、MTT可作为AIS-LVO患者HT发生的独立预测指标,PS、MTT的阈值内升高和CBF、CBV的阈值内降低可能帮助临床医生在临床实践中早期区分HT发生的风险以采取预防措施。Objective:To investigate the value of cerebral perfusion-weighted imaging in predicting the risk of hemorrhagic transformation(HT)in patients with acute ischemic stroke with large vessel occlusion(AIS-LVO)after mechanical thrombec-tomy.Methods:A total of 102 patients with AIS-LVO who underwent mechanical thrombectomy in our hospital from June2018 to June 2020 were enrolled.The complete clinical data of all patients were collected.CT perfusion imaging was performed both on affected side and contralateral side before treatment.The values of surface permeability(PS),cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),time to peak(TTP)were recorded.The cut-off value and predictive value of those indexes were analyzed through ROC curve.Chi-square test and multivariate regression analysis were used to analyze the correlation between those indexes and HT.Results:The incidence rate of HT was 38.24%(39/102),and there were 19 cases of symptomatic HT and 20 cases of asymptomatic HT.The age and NIHSS score of bleeding group were higher than those of non-bleeding group,and the r PS,rMTT,and rTTP of bleeding group were still higher than those of nonbleeding group before treatment(P<0.05),while rCBF and r CBV were lower than those of non-bleeding group.|r PS|,|rCBF|,|rCBV|,|rMTT|,and|rTTP|values in bleeding group were greater than those in non-bleeding group(P<0.05).|rPS|,|rCBF|,|r CBV|,|rMTT|,and|rTTP|were independent influencing factors for the occurrence of HT(P<0.05).The prediction model-fitting degree was the best of combined detection of five indicators,followed by MTT,PS,CBF,CBV,and TTP(AUC>0.7).Conclusion:The cerebral perfusion imaging indexes PS,CBF,CBV,and MTT before treatment can be used as independent predictors of HT,moreover,the increase of PS and MTT and the decrease of CBF and CBV within the threshold can be used to distinguish the risk of HT in early clinical practice and preventions.

关 键 词：机械溶栓 卒中 体层摄影术 螺旋计算机 

分 类 号：K743.3[历史地理—历史学] R814.42[历史地理—世界史]