入院时DRAGON评分及CTP低灌注强度比值对急性前循环大血管闭塞卒中取栓预后的预测价值  

Predictive value of DRAGON score and ratio of CTP low perfusion intensity on outcome of thrombectomy during acute anterior circulation macrovessel occlusion stroke

作　　者：汪星 任宏伟[2] 黄承芳[1] 彭军[1] 孙冬[3] WANG Xing;REN Hong-wei;HUANG Cheng-fang(Department of Neurology,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan Hubei 430064,China;Department of Medical Imaging,Tianyou Hospital Affiliated to Wuhan University of Science and Technology,Wuhan Hubei 430064,China)

机构地区：[1]武汉科技大学附属天佑医院神经内科,湖北武汉430064 [2]武汉科技大学附属天佑医院医学影像科,湖北武汉430064 [3]武汉大学中南医院神经内科,湖北武汉430064

出　　处：《临床和实验医学杂志》2023年第22期2361-2365,共5页Journal of Clinical and Experimental Medicine

基　　金：湖北省教育厅科学技术研究计划指导性项目(编号:B2021022)。

摘　　要：目的分析入院时脑卒中预后评分量表(DRAGON)评分及CT灌注成像(CTP)低灌注强度比值(HIR)对急性前循环大血管闭塞卒中取栓预后的预测价值。方法前瞻性选取2019年1月至2022年12月武汉科技大学附属天佑医院和武汉大学中南医院收治的120例急性前循环大血管闭塞卒中患者,治疗90 d后依据改良Rankin量表(mRS)评分,分为预后良好组(mRS为0~2分)和预后不良组(mRS为3~6分)。预后良好组69例,预后不良组51例。对比两组一般资料、静脉溶栓治疗(IVT)、发病至穿刺时间、发病至血管再通时间、机械取栓次数、HIR、CT指标、DRAGON评分。结果预后良好组的年龄、收缩压低于预后不良组,男性比例高于预后不良组,差异均有统计学意义(P<0.05)。预后良好组发病至血管再通时间及机械取栓次数均低于预后不良组,差异均有统计学意义(P<0.05)。预后良好组HIR、脑室间隙(IC)体积、低灌注区最大延迟时间比值(rTmaxa)及DRAGON评分低于预后不良组,低灌注区相对脑血流量(rCBFa)、低灌注区相对脑血流容积(rCBVa)高于预后不良组,差异均有统计学意义(P<0.05)。进行Logistic回归分析,分析结果:年龄、HIR、IC体积、DRAGON评分是急性前循环大血管闭塞卒中患者预后的影响因素(P<0.05);HIR预测急性前循环大血管闭塞卒中患者预后的ROC曲线下面积为0.870(95%CI:0.794~0.926),敏感度为0.843,特异度为0.826;IC体积预测急性前循环大血管闭塞卒中患者预后的ROC曲线下面积为0.928(95%CI:0.868~0.947),敏感度为0.863,特异度为0.812;DRAGON评分预测急性前循环大血管闭塞卒中患者预后的ROC曲线下面积为0.892(95%CI:0.833~0.935),敏感度为0.745,特异度为0.952;HIR、IC体积、DRAGON评分联合预测急性前循环大血管闭塞卒中患者预后的ROC曲线下面积为0.943(95%CI:0.899~0.967),敏感度为0.876,特异度为0.804。结论年龄、HIR、IC体积、DRAGON评分与急性前循环大血管闭塞卒Objective To analyze the predictive value of stroke prognosis rating scale(DRAGON)score and hypoperfusion intensity ratio(HIR)of CT perfusion imaging(CTP)on the prognosis of thrombectomy in acute anterior circulation large vessel occlusion stroke.Methods A total of 120 patients with acute anterior circulation large vessel occlusion stroke admitted to Tianyou Hospital Affiliated to Wuhan University of Science and Technology and Zhongnan Hospital of Wuhan University from January 2019 to December 2022 were prospectively selected.According to the modified Rankin scale(mRS)score after 90 days of treatment,the patients were divided into good prognosis group(mRS 0-2 points)and poor prognosis group(mRS 3-6 points),with 69 patients in the good prognosis group and 51 patients in the poor prognosis group.The two groups of general data,intravenous thrombolytic therapy(IVT),onset to puncture,onset to vascular recanalization,number of mechanical thrombectomy,HIR,CT index,and DRAGON score were compared.Results Age,systolic blood pressure in the good prognosis group were lower than those in the poor prognosis group,the proportion of men in the good prognosis group was higher than that in the poor prognosis group,the differences were statistically significant(P<0.05).The time of onset to vascular recanalization and the number of mechanical thrombectomy in the good prognosis group were lower than those in the poor prognosis group,the differences were statistically significant(P<0.05).The HIR,the volume of the ventricular space(IC volume),the maximum delay time ratio(rTmaxa)in the low perfusion area,and the DRAGON score in the good prognosis group were lower than those in the poor prognosis group,the differences were statistically significant(P<0.05),the relative cerebral blood flow(rCBFa)and low perfusion areas were higher than the poor prognosis groups(P<0.05);Performed the Logistic regression analysis,conclusion Age,HIR,IC volume,and DRAGON score were the outcome factors of patients with acute anterior circulation large vessel o

关 键 词：脑卒中预后评分量表 灌注成像 低灌注强度比值 急性前循环大血管闭塞卒中 发病至穿刺时间 脑室间隙的体积 

分 类 号：R743.3[医药卫生—神经病学与精神病学]