多时相血管成像技术联合计算机断层扫描灌注成像对急性大动脉闭塞性脑梗死患者阿替普酶治疗后早期再通的预测价值  

Predictive value of multi-temporal computer tomography angiography combined with computer tomography perfusion imaging in early recanalization after alteplase therapy in patients with acute cerebral infarction due to large artery occlusion

作　　者：周娟[1] 冯刚华 罗善琦 李海鹏[1] Zhou Juan;Feng Ganghua;Luo Shanqi;Li Haipeng(Department of Neurology,Chenzhou First People's Hospital,Chenzhou 423000,China)

机构地区：[1]湖南省郴州市第一人民医院神经内科,423000

出　　处：《心脑血管病防治》2022年第3期58-62,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：湖南省郴州市第一人民医院科研课题(N2020-63)。

摘　　要：目的 分析多时相血管成像技术(CTA)联合计算机断层扫描灌注成像(CTP)对急性大动脉闭塞性脑梗死患者阿替普酶治疗后早期再通的预测价值。方法 选取2018年1月至2020年12月于郴州市第一人民医院神经内科诊治的急性大动脉闭塞性脑梗死患者304例。根据患者应用阿替普酶治疗后早期再通情况分再通组和对照组。比较两组的一般资料、CTA和CTP的影像学特征等临床资料。应用多因素Logistic回归分析影响急性大动脉闭塞性脑梗死患者阿替普酶治疗后早期再通的相关因素,应用ROC曲线分析多时相CTA联合CTP预测急性大动脉闭塞性脑梗死患者应用阿替普酶治疗后早期再通的价值。结果 纳入研究的患者中有8例脱落;剩余296例患者中有85例应用阿替普酶治疗后有早期血管再通为再通组,剩余211例患者列为对照组,早期血管再通率为28.72%。再通组发病到溶栓时间、脑血容量(CBV)和平均通过时间(MTT)均短于对照组(t=5.466、9.809、6.799,P <0.05),再通组美国国立卫生研究院卒中量表评分(NIHSS)低于对照组(t=3.765,P <0.05),再通组黄褐色侧支循环评分(tan)高于对照组(t=6.957,P <0.05),再通组艾伯塔中风计划早期计算机断层扫描评分(ASPECTS)、脑血流量(CBF)和达峰时间(TTP)大于对照组(t=2.783、10.496、9.481,P <0.05)。多因素Logistic回归分析显示:tan评分、CBF和TTP是影响急性大动脉闭塞性脑梗死患者阿替普酶治疗后早期再通的独立危险因素(OR=2.559、1.151、1.283,P <0.01);发病到溶栓时间、CBV和MTT是影响急性大动脉闭塞性脑梗死患者阿替普酶治疗后早期再通的保护性因素(OR=0.433、0.080、0.843,P <0.01)。ROC曲线显示:CBF对急性大动脉闭塞性脑梗死患者应用阿替普酶治疗后早期再通的预测价值明显高于tan评分、TTP、发病到溶栓时间、CBV和MTT,其中CBF值的最佳截点为≤35.54 mL/(100 mg·min),此时敏感度65.92%、特异度80.61%。Objective To analyze the predictive value of multi-temporal computer tomography angiography(CTA) combined with computer tomography perfusion imaging(CTP) in the early recanalization of patients with acute cerebral infarction due to large artery occlusion after alteplase therapy. Methods 304 cases of acute cerebral infarction due to large artery occlusion diagnosed and treated in the department of neurology in Chenzhou First People’s Hospital from January 2018 to December 2020 were analyzed. Patients were divided into recanalization group and control group according to their early recanalization situation after treatment with alteplase. The general imformation, imaging features of CTA and CTP were compared between the two groups. Multivariate logistic regression was used to analyze the factors affecting the early recanalization of patients with acute cerebral infarction due to large artery occlusion after alteplase treatment, and ROC curve was used to analyze the value of multi-temporal CTA combined with CTP in predicting the early recanalization of patients withacute cerebral infarction due to large artery occlusion treated with alteplase. Results 8 patients were dropped out. Among the remained 296 patients, 85 patients with early vascular recanalization after treatment with alteplase were classified as the recanalization group, while the remained 211 patients were classified as the control group. The early vascular recanalization rate was 28.72%. The time from onset to thrombolysis, cerebral blood volume(CBV) and mean transit time(MTT) in the recanalization group were shorter than those in the control group(t=5.466, 9.809, 6.799;P < 0.05). The National Institute of Health Stroke Scale Score(NIHSS) in the recanalization group was lower than that in the control group(t=3.765, P < 0.05), the tan collateral circulation score(tan) in the recanalization group was higher than that in the control group(t=6.957, P < 0.05), the Alberta stroke program early computer tomography score(ASPECTS), cerebral blood flow(CBF) and

关 键 词：多时相血管成像技术 计算机断层扫描灌注成像 急性大动脉闭塞性脑梗死 阿替普酶 早期再通 

分 类 号：R743.33[医药卫生—神经病学与精神病学]