单侧大脑中动脉慢性闭塞患者FLAIR高信号血管征变化规律及对脑梗死的预测价值  

Changes of FLAIR hyperintense vascular signs in patients with middle cerebral artery chronic occlusion and the predictive value of cerebral infarction

作　　者：卢万俊[1] 彭剑[2] 徐春富[1] 韩长鸣 高峰 沈洁玲 竺峰 景国亮 孙成团 LU Wanjun;PENG Jian;XU Chunfu(Department of Neurology,Yangzhou Jiangdu People’s Hospital,Yangzhou 225200,China)

机构地区：[1]扬州市江都人民医院神经内科,江苏扬州225200 [2]扬州市江都人民医院影像科,江苏扬州225200

出　　处：《中风与神经疾病杂志》2022年第2期143-146,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨单侧大脑中动脉慢性闭塞患者液体衰减反转恢复序列(fluid attenuated inversion recovery,FLAIR)高信号血管征(hyperintense vascular sign,HVS)变化规律及对脑梗死预测作用。方法纳入2016年7月-2021年8月在住院并首次发现单侧大脑中动脉慢性闭塞患者。根据有无脑梗死,将其分为非脑梗死组和脑梗死组;根据随访过程中脑梗死是否复发,将脑梗死组分为复发组和未复发组。应用多变量Logistic回归模型及ROC曲线分析,FVHs与单侧大脑中动脉慢性闭塞患者发生脑梗死及脑梗死复发的风险及其预测价值。结果(1)单因素分析显示,脑梗死组纤维蛋白原水平、存在HVS征象及FVHs评分均显著高于非脑梗死组(P<0.05);脑梗死复发患者基线FVHs评分显著高于未复发患者的基线FVHs(P<0.05);(2)Logistic回归分析显示,FVHs评分与首次发生脑梗死存在显著独立正相关(OR=2.499;95%CI 1.481~4.218;P=0.001),而FVHs评分与脑梗死复发不存在显著独立相关(OR1.356;95%CI 0.922~1.994;P=0.112);(3)ROC曲线分析,FVHs评分≥4分时对于单侧大脑中动脉慢性闭塞患者发生脑梗死有一定预测价值,其敏感性73.3%,特异性66.2%,曲线下面积(AUC)0.669(95%CI 0.476~0.861;P=0.041)。结论对于单侧大脑中动脉慢性闭塞患者,HVS可能变化规律为从无到有的过程,而一旦出现HVS征象则提示脑血流向失代偿进展,极易发生脑梗死,FHVs评分对于脑梗死发生有一定预测价值。Objective To investigate the effect of fluid attenuated inversion recovery(FLAIR)on hyperintense vascular sign in patients with unilateral middle cerebral artery chronic occlusion.Changes of HVS and prediction of cerebral infarction were also analyzed.Methods Patients with unilateral middle cerebral artery chronic occlusion who were hospitalized in Jiangdu People’s Neurology Department of Yangzhou City from July 2016 to August 2021 were enrolled.According to the presence or absence of cerebral infarction,they were divided into non-cerebral infarction group and cerebral infarction group.According to whether the cerebral infarction recurred during the follow-up,the cerebral infarction group was divided into recurrence group and non-recurrence group.Multivariate logistic regression model and ROC curve were used to analyze the risk and predictive value of FVHs and cerebral infarction in patients with unilateral middle cerebral artery chronic occlusion.Results(1)Univariate analysis showed that the fibrinogen level,HVS signs and FVHs score in cerebral infarction group were significantly higher than those in non-cerebral infarction group(P<0.05).The baseline FVHs score of recurrent cerebral infarction patients were significantly higher than that of non-recurrent cerebral infarction patients(P<0.05).(2)Logistic regression analysis showed that FVHs score had a significant independent positive correlation with the first occurrence of cerebral infarction(OR=2.499;95%CI 1.481~4.218;P=0.001),and FVHs score was not independently associated with cerebral infarction recurrence(OR=1.356;95%CI 0.922~1.994;P=0.112);(3)ROC curve analysis showed that FVHs score≥4 had certain predictive value for cerebral infarction in patients with unilateral middle cerebral artery chronic occlusion,with sensitivity of 73.3%,specificity of 66.2%,area under curve(AUC)of 0.669(95%CI 0.476~0.861;P=0.041).Conclusion For patients with unilateral middle cerebral artery chronic occlusion,HVS may change in a process from scratch,and once the occurrence o

关 键 词：大脑中动脉 动脉闭塞性疾病 卒中 脑缺血 磁共振血管造影术 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]