基于残余组织达峰时间的血流动力学变化预测急性前循环缺血性卒中脑组织水肿严重程度的研究  

A study on the severity of brain tissue edema in acute anterior circulation ischemic stroke based on time to maximum of the residual function hemodynamic changes

作　　者：沈连芳 房伟[1] 张焕磊 王慧颖 陆秀娣 夏爽 Shen Lianfang;Fang Wei;Zhang Huanlei;Wang Huiying;Lu Xiudi;Xia Shuang(Department of Radiology,Yidu Central Hospital of Weifang,Qingzhou 262500,China;The School of Medicine,Nankai University,Tianjin 300071,China;Department of Radiology,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China;Department of Radiology,Tianjin First Central Hospital,Medical Imaging Institute of Tianjin,School of Medicine,Nankai University,Tianjin 300192,China)

机构地区：[1]山东省潍坊市益都中心医院医学影像科,青州262500 [2]南开大学医学院,天津300071 [3]天津中医药大学第一附属医院医学影像科,天津300193 [4]天津市第一中心医院放射科、天津市医学影像研究所、南开大学医学院,天津300192

出　　处：《中华放射学杂志》2023年第7期733-740,共8页Chinese Journal of Radiology

基　　金：国家自然科学基金(82171916,81871342);天津市卫生健康科技项目(TJWJ2022XK019);潍坊市卫健委科研项目计划(WFWSJK-2020-005)。

摘　　要：目的探讨基于残余组织达峰时间(T_(max))延迟严重程度的加权Wilcoxon-Mann-Whitney广义优势比(T_(max)加权比)预测急性前循环缺血性卒中脑组织中重度水肿的价值。方法回顾性分析2019年1月至2022年4月就诊于潍坊市益都中心医院的急性前循环缺血性卒中患者的临床及影像资料。共入组85例患者,男60例,女25例,年龄34~93(67±11)岁。患者均接受头颅CT平扫、头颈部CT血管成像及头颅CT灌注成像,评估责任血管供血区侧支循环情况,测量梗死核心体积及T_(max)4~6 s体积、T_(max)6~8 s体积、T_(max)8~10 s体积、T_(max)>10 s体积及其相对于整个低灌注区(T_(max)>4 s体积)的比例,并计算T_(max)加权比。根据24~48 h平扫CT中脑肿胀是否超过单侧大脑半球1/3,将患者分为轻度水肿组及中重度水肿组。采用独立样本t检验、Mann-Whitney U检验或χ^(2)检验比较2组各指标的差异。利用受试者操作特性(ROC)曲线评估T_(max)加权比预测中重度水肿的效能。利用单因素及多因素logistic回归评估中重度水肿发生的风险因素。通过1∶1倾向性评分匹配(PSM)均衡2组间基线美国国立卫生研究院卒中量表(NIHSS)评分和梗死核心体积的差别,并进一步比较T_(max)加权比的差异。结果入组患者中轻度水肿组52例,中重度水肿组33例。中重度水肿组基线NIHSS评分、T_(max)>10 s体积、梗死核心体积、T_(max)加权比及不良侧支循环比例高于轻度水肿组(P<0.001),T_(max)4~6 s体积较轻度水肿组小(P<0.001)。PSM前,ROC分析显示T_(max)加权比预测中重度水肿发生的曲线下面积(AUC)为0.885(95%CI 0.798~0.944),最佳截断值为1.17,灵敏度为84.85%,特异度为82.69%。T_(max)加权比预测中重度水肿发生的AUC与梗死核心体积(Z=0.64,P=0.520)、T_(max)4~6 s体积(Z=1.48,P=0.140)差异无统计学意义,但优于T_(max)6~8 s体积(Z=5.65,P<0.001)、T_(max)8~10 s体积(Z=4.46,P<0.001)、T_(max)>10 s体积(Z=2.91,P=0.004);多因素lObjective To explore the value of the Wilcoxon-Mann-Whitney generalized dominance ratio(T_(max)-weighted ratio)based on residual tissue time to peak(T_(max))delayed severity weighting in predicting the moderate to severe edema after acute anterior circulation ischemic stroke.Methods The clinical and imaging features of patients with acute anterior circulation ischemic stroke from January 2019 to April 2022 in Yidu Central Hospital of Weifang were retrospectively analyzed.A total of 85 patients were enrolled,including 60 males and 25 females,with the age from 34 to 93(67±11)years old.Patients underwent non-contrast CT,CT angiography of the head and neck,and CT perfusion imaging of the head,and ischemic core volume and the ratio of T_(max)4-6 s volume,T_(max)6-8 s volume,T_(max)8-10 s volume,and T_(max)>10 s volume relative to the entire hypo-perfused area(T_(max)>4 s volume)was measured,and the T_(max)-weighted ratio was calculated,the collateral circulation were assessed.Patients were divided into mild edema group and moderate to severe edema group according to whether local swelling exceeded 1/3 of the unilateral cerebral hemisphere on non-contrast CT at 24-48 h.The indicators were compared between the two groups by independant t test,Mann-Whitney U andχ^(2)test.The performance to predict moderate to severe edema was assessed using the receiver operating characteristic(ROC)curve.The univariate and multivariate logistic regression was used to analyze the risk factors for the moderate to severe edema.Differences in baseline National Institutes of Health Stroke Scale(NIHSS)score and infarct core volume were equalized by 1∶1 propensity score matching(PSM)and the differences of T_(max)-weighted ratio between the two groups were further compared.Results There were 52 cases in the mild edema group and 33 cases in the moderate to severe edema group.Baseline NIHSS score,T_(max)>10 s volume,ischemic core volume,T_(max)-weighted ratio and proportion of poor collateral circulation were higher in the moderate-severe edem

关 键 词：脑缺血 卒中 血液灌注 体层摄影术 X线计算机 脑水肿 

分 类 号：R743.3[医药卫生—神经病学与精神病学]