急性缺血性脑卒中患者血管内介入术后颅内高密度灶与进展性脑卒中的关系  

Relationship between intracranial high-density foci and progressive stroke in patients with acute ischemic stroke after intravascular intervention

作　　者：何晓清[1] 黄丹丹[2] 黄汉宁[2] 邓新源[1] 程建波 罗志程[1] He Xiaoqing;Huang Dandan;Huang Hanning;Deng Xinyuan;Cheng Jianbo;Luo Zhicheng(Department of Medical Imaging,Gaozhou People′s Hospital,Gaozhou 525200,China;Department of Neurology,Gaozhou People′s Hospital,Gaozhou 525200,China)

机构地区：[1]高州市人民医院医学影像科,高州525200 [2]高州市人民医院神经内科,高州525200

出　　处：《中华神经科杂志》2024年第4期375-382,共8页Chinese Journal of Neurology

基　　金：广东省医学科学技术研究基金(A2020218);广东省茂名市科技计划(190404151701037)。

摘　　要：目的采用双能量CT量化急性缺血性脑卒中(AIS)患者经血管内介入术后颅内的高密度灶,探讨高密度灶与进展性脑卒中(PS)发病之间的关系。方法回顾性分析2019年5月至2020年8月在高州市人民医院经血管内介入治疗的92例AIS患者,患者经介入术后即刻行颅脑双能量CT,将卒中发生72 h内美国国立卫生研究院卒中量表(NIHSS)评分增加≥4分的患者纳入PS组(n=35),<4分的患者纳入非PS组(n=57),比较两组患者的临床资料、高密度灶体积及CT值之间的差异,采用Logistic回归分析校正混杂因素并筛选危险因素,同时将入院NIHSS评分、是否存在高密度灶及高密度灶体积、最大CT值(CTmax值)、平均CT值(CTave值)与PS发病进行相关性分析,应用受试者工作特征曲线进一步筛选PS发病的可能预测指标。结果PS组患者的入院NIHSS评分[(18.80±8.50)分比(14.40±9.58)分,t=2.229,P=0.028]、存在高密度灶的比例[29/35(82.9%)比32/57(56.1%),χ^(2)=6.928,P=0.008]、高密度灶的体积[13.23(39.33)cm^(3)比0.76(9.82)cm^(3),U=1440.000,P<0.001]、CTmax值[80.00(92.00)HU比65.00(87.50)HU,U=1337.000,P=0.005]及CTave值[53.48(23.79)HU比45.94(55.11)HU,U=1345.000,P=0.004]均高于非PS组,差异均有统计学意义。入院NIHSS评分(OR=1.054,95%CI 1.004~1.106,P=0.033;rs=0.255,95%CI 0.051~0.447,P=0.014)、存在高密度灶(OR=3.776,95%CI 1.358~10.503,P=0.011;rs=0.274,95%CI 0.093~0.460,P=0.008)、高密度灶体积(OR=1.026,95%CI 1.003~1.049,P=0.027;rs=0.381,95%CI 0.183~0.560,P<0.001)、CTmax值(OR=1.006,95%CI 1.001~1.011,P=0.014;rs=0.292,95%CI 0.088~0.475,P=0.005)及CTave值(OR=1.021,95%CI 1.007~1.035,P=0.004;rs=0.299,95%CI 0.092~0.484,P=0.004)均是影响PS发病的危险因素并与PS发病呈正相关。患者的入院NIHSS评分、高密度灶体积、CTmax值及CTave值预测PS发病的受试者工作特征曲线下面积分别为0.652、0.722、0.670、0.674,高密度灶的体积对PS发病具有中等预测价值。结论AIS患者在介入术后应即Objective To investigate the relationship between intracerebral high-density foci and progressive stroke(PS)morbidity by using dual-energy CT,which can quantify the intracerebral high-density foci of patients with acute ischemic stroke after endovascular treatment.Methods Ninety-two patients with acute ischemic stroke who received interventional treatment in Gaozhou People′s Hospital from May 2019 to August 2020,and underwent dual-energy CT scan immediately after intervention,were analyzed.The patients were divided into PS group(n=35)and non-PS group(n=57)according to the National Institutes of Health Stroke Scale(NIHSS)score,and the patients whose NIHSS score increased≥4 points within 72 hours of stroke were included in the PS group,while the patients whose NIHSS score increased<4 points were included in the non-PS group.The clinical data,volume of high-density foci and CT values were compared between the 2 groups.Logistic regression analysis was used to adjust for confounding factors and screen for risk factors.The correlations of the admission NIHSS score,presence and volume of high-density lesions,maximum CT(CTmax)value and average CT(CTave)value with the onset of PS were analyzed,and the receiver operating characteristic curve was used to screen predictive indicators of PS.Results In the PS group,the NIHSS score(18.80±8.50 vs 14.40±9.58,t=2.229,P=0.028),proportion of high-density foci[29/35(82.9%)vs 32/57(56.1%),χ^(2)=6.928,P=0.008],high-density focal volume[13.23(39.33)cm^(3)vs 0.76(9.82)cm^(3),U=1440.000,P<0.001],CTmax value[80.00(92.00)HU vs 65.00(87.50)HU,U=1337.000,P=0.005]and CTave value[53.48(23.79)HU vs 45.94(55.11)HU,U=1345.000,P=0.004]were higher than those in the non-PS group.The NIHSS score(OR=1.054,95%CI 1.004-1.106,P=0.033;rs=0.255,95%CI 0.051-0.447,P=0.014),presence of high-density foci(OR=3.776,95%CI 1.358-10.503,P=0.011;rs=0.274,95%CI 0.093-0.460,P=0.008),high-density focal volume(OR=1.026,95%CI 1.003-1.049,P=0.027;rs=0.381,95%CI 0.183-0.560,P<0.001),CTmax value(OR=1.006,95%CI 1.001-1

关 键 词：缺血性卒中 介入治疗 体层摄影术 X线计算机 造影剂 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]