颅内动脉钙化对急性脑梗死患者溶栓治疗的临床预后影响  

Effect of intracranial arterial calcification on the clinical prognosis of thrombolytic therapy in patients with acute cerebral infarction

作　　者：刘潇 余浩佳 辛世萌[1] LIU Xiao;YU Haojia;XIN Shimeng(Department of Neurology and Intensive Care,Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连医科大学附属第二医院神经医学重症科,辽宁大连116023

出　　处：《分子影像学杂志》2022年第4期584-589,共6页Journal of Molecular Imaging

摘　　要：目的探讨颅内动脉钙化程度对接受溶栓治疗的急性脑梗死患者临床预后的影响。方法回顾性收集接受静脉溶栓治疗的急性前循环脑梗死患者共124例。采用90 d改良Rankin量表,把患者分为预后良好组(n=87)及预后不良组(n=37)。收集患者就诊时完善的颅脑CT,用图像处理软件ImageJ测量责任动脉侧颅内段颈内动脉虹吸段的钙化容积,并收集可能影响患者预后的其他临床指标,进行单因素分析,对影响患者预后的因素进一步应用Logistic回归分析,明确颅内动脉钙化是否为患者预后不良的独立危险因素。最后,计算钙化容积及溶栓前美国国立卫生研究院卒中量表(NIHSS)评分的联合预测因子,采用Medcalc 18.2.1统计软件,绘制溶栓前NIHSS评分的曲线及联合预测因子的ROC曲线,计算两者曲线下面积,比较两种指标间曲线下面积的差异显著性。结果钙化容积是接受静脉溶栓治疗的急性前循环脑梗死患者预后不良的独立危险因素(OR=1.10,95%CI=1.05~1.21)。溶栓前NIHSS评分的曲线下面积为0.77,95%CI为0.69~0.85,截点值为5分,敏感度为75.7%,特异性为72.4%;溶栓前NIHSS评分联合钙化容积的曲线下面积为0.83,95%CI为0.75~0.89,敏感度为75.7%,特异性为80.5%。相较于单独应用溶栓前NIHSS评分,联合预测因子对患者预后情况的预测价值更高,两者间差异有统计学意义(Z=2.21,P=0.027)。结论钙化容积与急性前循环脑梗死患者溶栓后预后不良独立相关,可以构成判断患者溶栓后预后情况的指标,且溶栓前NIHSS评分联合钙化容积对患者预后情况的预测价值优于单独应用溶栓前NIHSS评分。Objective To investigate the effect of intracranial artery calcification on the clinical prognosis of patients with acute cerebral infarction who received thrombolytic therapy,in order to predict the prognosis positively.Methods A total of 124 patients with acute anterior circulation cerebral infarction were retrospectively collected.The 90-day modified Rankin scale was used to divide the patients into a good prognosis group(n=87)and a poor prognosis group(n=37).We collected the perfect brain CT at the time of the patient's visit,and used the image processing software ImageJ to measure the calcification volume of the siphon segment of the intracranial carotid artery on the side of the responsible artery.Logistic regression analysis was further applied to the factors affecting the prognosis of patients to determine whether intracranial artery calcification was an independent risk factor for poor prognosis of patients.Finally,the combined predictors of the calcification volume and the NIHSS score before thrombolysis were calculated.ROC curve was drawn by the predictor and pre-thrombolysis NIHSS scores,AUCs were calculated,and the significance of the difference in AUC between two indicators was compared.Results Calcified volume was an independent risk factor for patients with acute anterior circulation cerebral infarction treated with intravenous thrombolysis(OR=1.10,95%CI=1.05-1.21).The pre-thrombolytic NIHSS score showed that AUC was 0.77,95%CI was 0.69-0.85,cut-off value was 5,sensitivity was 75.7%and specificity was 72.4%.The pre-thrombolytic NIHSS score combined with calcified volume showed that AUC was 0.83,95%CI was 0.75-0.89,sensitivity was 75.7%and specificity was 80.5%.The combined predictor was more predictive of patient prognosis than the pre-thrombolysis NIHSS score alone(Z=2.21,P=0.027).Conclusion Calcification volume is independently associated with poor prognosis in patients with acute anterior circulation cerebral infarction receiving thrombolysis,which can constitute an indicator for judging the pr

关 键 词：颅内动脉钙化 静脉溶栓 前循环脑梗死 临床预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]