相对残余功能达峰时间对成人烟雾病血管搭桥术后脑梗死的预测作用  

Role of relative time to maximum of the residual function in predicting infarction after cerebral vascular bypass surgery in adult moyamoya disease

作　　者：丁江波[1,2] 马培玉 常戌颖 张若愚 杨光武 牟临杰 张兴逵[1] 李智高 汤进伟[2] 汤志伟 Ding Jiangbo;Ma Peiyu;Chang Xuying;Zhang Ruoyu;Yang Guangwu;Mu Linjie;Zhang Xingkui;Li Zhigao;Tang Jinwei;Tang Zhiwei(Department of Neurosurgery,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Neurosurgery,South Yunnan Central Hospital of Yunnan Province(the First People′s Hospital of Honghe Prefecture),Mengzi 661199,China)

机构地区：[1]昆明医科大学第一附属医院神经外科,昆明650032 [2]云南省滇南中心医院(红河州第一人民医院)神经外科,蒙自661199

出　　处：《中华神经外科杂志》2023年第9期909-915,共7页Chinese Journal of Neurosurgery

基　　金：云南省神经系统疾病临床医学中心研究项目(ZX2019-03-05);云南省"高层次人才培养支持计划"青年拔尖人才专项基金(RLTZW20210629);535人才计划基金(2022535D04)。

摘　　要：目的探讨成人烟雾病患者血管搭桥术后发生脑梗死的危险因素,寻找可预测术后脑梗死发生的参数。方法回顾性分析2019年9月至2022年12月昆明医科大学第一附属医院神经外科连续收治的83例成人烟雾病患者的临床资料。所有患者均接受颞浅动脉-大脑中动脉吻合术联合脑-硬脑膜-肌肉血管融合术治疗。根据术后1周内是否出现新发脑梗死,分为脑梗死组和无脑梗死组。采用单因素分析和多因素logistic回归分析探讨影响患者术后发生脑梗死的危险因素。进一步对危险因素进行受试者工作特征(ROC)曲线分析,明确其预测脑梗死发生的最佳阈值、灵敏度和特异度。结果83例患者中,脑梗死组11例,无脑梗死组72例。两组患者的年龄、性别、高血压病史、高脂血症、吸烟史、起病类型、手术侧别、Suzuki分期,以及后循环是否受累的差异均无统计学意义(均P>0.05)。术前CT灌注成像参数中,脑梗死组与无脑梗死组患者的相对脑血容量(中位数)(1.18对比0.94,P=0.002)、相对平均通过时间(2.79±0.58对比1.66±0.69,P<0.001)和相对残余功能达峰时间(rTmax,中位数)(3.18对比1.59,P<0.001)的差异均有统计学意义;而两组相对脑血流量的差异无统计学意义(P=0.121)。多因素logistic回归分析结果显示,仅rTmax为成人烟雾病患者术后发生脑梗死的独立危险因素(OR=36.61,95%CI:1.95~687.23,P=0.016)。ROC曲线分析显示,rTmax预测成人烟雾病术后脑梗死发生的曲线下面积为0.970(95%CI:0.93~1.00,P<0.001);其最佳阈值为2.104,灵敏度为1.000,特异度为0.847。结论rTmax增大可能能够预测成人烟雾病患者血管搭桥术后脑梗死的发生,且具有较高的灵敏度。Objective To explore the risk factors of cerebral infarction after bypass surgery in adult patients with moyamoya disease(MMD),and to determine the parameters that can predict the occurrence of cerebral infarction post operation.Methods The clinical data of 83 adult MMD patients admitted to the Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University from September 2019 to December 2022 were retrospectively analyzed.All patients were treated with combined bypass surgery(superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-myo-synangiosis).Based on whether there was a new-onset cerebral infarction within 1 week after operation,all patients were divided into cerebral infarction group and non-cerebral infarction group.Univariate analysis and multivariate logistic regression analyses were used to explore the risk factors of postoperative cerebral infarction.Furthermore,the independent risk factors were analyzed by receiver operating characteristic(ROC)curve to determine the best threshold,test sensitivity and specificity for predicting the occurrence of cerebral infarction.Results Among the 83 patients,11 cases had new cerebral infarction and 72 cases had no new cerebral infarction within 1 week after operation.There were no significant differences in age,sex,history of hypertension,hyperlipidemia,history of smoking,type of onset,Suzuki stage,involvement of posterior circulation or the side of surgical intervention between the two groups(all P>0.05).There were significant differences in preoperative CT perfusion parameters between cerebral infarction group and non-infarction group,including relative cerebral blood volume(median)(1.18 vs.0.94,P=0.002),relative mean transit time(2.79±0.58 vs.1.66±0.69,P<0.001)and relative time to maximum of the residual function(median,rTmax)(3.18 vs.1.59,P<0.001),whereas the difference between the two groups in rCBF was not significant(P=0.121).Multivariate logistic regression analysis showed that rTmax was the

关 键 词：脑底异常血管网病 脑血管重建术 脑梗死 危险因素 CT灌注成像参数 相对残余功能达峰时间 

分 类 号：R651.1[医药卫生—外科学]