头颈部CTA联合动态动脉硬化指数在急性分水岭脑梗死中的诊断及预后价值分析  

Study on the diagnostic and prognostic value of head and neck CTA combined with ambulatory arterial stiffness index in acute cerebral watershed infarction

作　　者：吕志坤[1] 魏萌萌 李国珍[1] 张晓红[2] 刘海龙 贾磊华 冯志霞 卢波[1] 沈丹平[4] LÜZhikun;WEI Mengmeng;LI Guozhen;ZHANG Xiaohong;LIU Hailong;JIA Leihua;FENG Zhixia;LU Bo;SHEN Danping(Department 2 of Neurology,Baoding Second Central Hospital,Baoding,Hebei 072750,China;Department 1 of Neurology,Baoding Second Central Hospital,Baoding,Hebei 072750,China;Disinfection Supply Center,Baoding Second Central Hospital,Baoding,Hebei 072750,China;CT Room,Baoding Second Central Hospital,Baoding,Hebei 072750,China;Anxin County Hospital of Hebei Province,Baoding,Hebei 072750,China)

机构地区：[1]保定市第二中心医院神经内二科 [2]保定市第二中心医院神经内一科 [3]保定市第二中心医院消毒供应中心 [4]保定市第二中心医院CT室 [5]河北省安新县医院,河北省保定市072750

出　　处：《中国动脉硬化杂志》2022年第11期966-973,1012,共9页Chinese Journal of Arteriosclerosis

基　　金：保定市科技计划项目(2141ZF025)。

摘　　要：[目的]探讨计算机断层扫描血管成像(CTA)联合动态动脉硬化指数(AASI)在急性分水岭脑梗死(ACWI)中的诊断及预后价值。[方法]前瞻性收集2018年7月—2020年9月于保定市第二中心医院神经内科接受治疗的292例缺血性脑血管病患者,所有患者均行头颅磁共振弥散成像(DWI)检查,并根据DWI检查结果分为ACWI组(n=134)和非ACWI组(n=158),所有患者均行头颈部CTA检查、颈部血管超声,检测患者有无颈动脉斑块、斑块性质、斑块位置以及头颈部血管有无狭窄、狭窄部位及狭窄情况;利用美国国立卫生研究院脑卒中量表(NIHSS)评估患者预后,比较两组患者的一般临床资料、入院及出院时的NIHSS评分、动态动脉硬化指数(AASI)、头颈部血管有无狭窄、狭窄部位及狭窄情况等。多因素分析采用Logistic回归模型。Pearson检验分析ACWI患者AASI与头颈部CTA检查结果的相关性。采用ROC曲线对头颈部CTA检测指标、AASI对ACWI的影响进行评估;通过建立Cox比例风险回归模型对影响ACWI患者预后的因素进行多变量分析。[结果]入院时平均动脉压为ACWI的保护因素(P<0.05),病灶侧颈内动脉(ICA)狭窄程度、病灶侧MCA狭窄程度、病灶侧多支血管狭窄、AASI为ACWI的独立危险因素(P<0.05)。ASSI与ICA狭窄程度、MCA狭窄程度、狭窄血管支数均呈明显正相关(P<0.001)。头颈部CTA联合AASI对ACWI的诊断价值大于各研究指标单独对ACWI的诊断价值(P<0.05)。出院时NIHSS评分、病灶侧ICA重度狭窄、病灶侧MCA重度狭窄、病灶侧多支血管狭窄、AASI均是影响ACWI患者预后的关键风险因素(P<0.05)。[结论]病灶侧ICA狭窄程度、病灶侧MCA狭窄程度、病灶侧多支血管狭窄、AASI为ACWI的独立危险因素,临床上可通过头颈部CTA联合AASI对ACWI患者进行早期诊断治疗,改善患者预后。Aim To study the diagnostic and prognostic value of head and neck computed tomography angiography(CTA) combined with ambulatory arterial stiffness index in acute cerebral watershed infarction(ACWI). Methods 292 patients who met the diagnostic criteria of ischemic cerebrovascular disease in the Department of Neurology of Baoding Second Central Hospital from July 2018 to September 2020 were prospectively collected. All patients were examined by diffusion weighted imaging(DWI). According to the results of DWI, patients were divided into ACWI group(n=134) and non-ACWI group(n=158). All patients underwent head and neck CTA examination and neck ultrasound, to detect the presence, nature and location of carotid plaque and the stenosis, location and stenosis of head and neck vessels in patients. The prognosis of the patients was evaluated with the NIHSS. The general clinical data, NIHSS score at admission and discharge, ambulatory arterial stiffness index(AASI), vascular stenosis in the head and neck, location and stenosis were compared between the two groups. Multivariate analysis was conducted using Logistic regression model. Pearson test was used to analyze the correlation between AASI and head and neck CTA in patients with ACWI. ROC curve was used to evaluate the detection index of CTA in the head and neck and the effect of AASI on ACWI, and the factors affecting the prognosis of patients with ACWI were analyzed by establishing Cox proportional hazard regression model. Results Mean arterial pressure was the protective factor of ACWI on admission(P<0.05). The degree of internal carotid artery(ICA) stenosis on the lesion side, the stenosis degree of MCA on the lesion side, the stenosis of multiple vessels on the lesion side and AASI were independent risk factors for ACWI(P<0.05). ASSI was positively correlated with the degree of ICA stenosis, the degree of MCA stenosis and the number of stenotic vessels(P<0.001). The diagnostic value of head and neck CTA combined with AASI in ACWI was greater than that in ACWI alone(P<

关 键 词：计算机断层扫描血管成像 动态动脉硬化指数 急性分水岭脑梗死 诊断价值 预后价值 

分 类 号：R741[医药卫生—神经病学与精神病学] R5[医药卫生—临床医学]