多模态CT成像对急性缺血性脑卒中患者静脉溶栓后早期神经功能恶化的预测价值  

Predictive value of multimodal CT imaging for early neurological deterioration in patients with acute ischemic stroke after intravenous thrombolysis

作　　者：王雪扬 孙昕 葛宏艳 于泳 张娴娴[2] 李运健 张森皓 李艳 WANG Xueyang;SUN Xin;GE Hongyan;YU Yong;ZHANG Xianxian;LI Yunjian;ZHANG Senhao;LI Yan(Department of Radiology,Yancheng Traditional Chinese Medicine Hospital,Jiangsu Province,Yancheng224001,China;Department of Neurology,Yancheng Third People’s Hospital,Jiangsu Province,Yancheng224001,China;Department of Radiology,Yancheng Third People’s Hospital,Jiangsu Province,Yancheng224001,China;Department of Radiology and Nuclear Medicine,Xuanwu Hospital Capital Medical University,Beijing100053,China)

机构地区：[1]江苏省盐城市中医院放射科,江苏盐城224001 [2]江苏省盐城市第三人民医院神经内科,江苏盐城224001 [3]江苏省盐城市第三人民医院放射科,江苏盐城224001 [4]首都医科大学宣武医院放射与核医学科,北京100053

出　　处：《中国医药导报》2024年第18期159-163,共5页China Medical Herald

摘　　要：目的探讨多模态CT成像对急性缺血性脑卒中(AIS)患者静脉溶栓后早期神经功能恶化(END)的预测价值。方法回顾性分析2018年3月至2022年9月于江苏省盐城市中医院和江苏省盐城市第三人民医院脑卒中中心接受静脉溶栓治疗的131例AIS患者的临床资料。根据是否发生END将其分为非END组(110例)和END组(21例)。比较两组临床资料,分析多模态CT图像指标对AIS患者静脉溶栓后END发生的影响因素,采用受试者操作特征(ROC)曲线评估多模态CT图像指标对AIS患者静脉溶栓后END发生的预测价值。结果END组Alberta卒中项目早期CT评分、区域软脑膜侧支循环(r LMC)评分均低于非END组,梗死核心体积、低灌注体积和缺血半暗带体积均大于非END组,溶栓24 h后出血率高于非END组,差异有统计学意义(P<0.05)。对年龄、性别、体重指数、吸烟、高血压病、糖尿病、心房颤动、入院NIHSS评分、入院到治疗时间及溶栓24 h后出血等进行校正后,r LMC评分(OR=0.61)、梗死核心体积(OR=1.04)、低灌注体积(OR=1.02)和缺血半暗带体积(OR=1.01)是AIS患者静脉溶栓后END发生的影响因素(P<0.05)。ROC曲线分析显示,低灌注体积预测AIS患者静脉溶栓后END发生的曲线下面积最高,缺血半暗带体积最低。结论RLMC评分、低灌注体积、梗死核心体积和缺血半暗带体积对AIS患者静脉溶栓后END发生有独立预测价值。Objective To investigate the predictive value of multimodal CT imaging for early neurological deterioration(END)in patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods Clinical data of 131 AIS patients received intravenous thrombolysis treatment at Stroke Center of Yancheng Traditional Chinese Medicine Hospital in Jiangsu Province and Yancheng Third People’s Hospital in Jiangsu Province from March 2018 to September 2022 were retrospectively analyzed.According to whether END occurred,they were divided into the non-END group(110 cases)and the END group(21 cases).Clinical data of the two group were compared,and the influencing factors of multimodal CT imaging indexes on the occurrence of END after intravenous thrombolysis in AIS patients were analyzed.Receiver operator characteristic(ROC)curve was used to predict the diagnostic value of multimodal CT imaging indexes for the occurrence of END after intravenous thrombolysis in AIS patients.Results Alberta stroke program early CT score,region leptomeningel collateral(rLMC)score in the END group were lower than those in the non-END group,infarct core volume,low perfusion volume,and ischemic penumbra volume in the END group were larger than those in the non-END group,the bleeding rate after 24 hours of thrombolysis in the END group was higher than that in the non-END group,and the differences were statistically significant(P<0.05).After correction for age,sex,body mass index,smoking,hypertensive disease,diabetes mellitus,atrial fibrillation,admission NIHSS score,admission-to-treatment time,and the bleeding rate after 24 hours of thrombolysis,rLMC score(OR=0.61),infarct core volume(OR=1.04),low perfusion volume(OR=1.02),and ischemic penumbra volume(OR=1.01)were the influencing factors for the occurrence of END after intravenous thrombolysis in AIS patients(P<0.05).ROC curve analysis showed that area under the curve of low perfusion volume predicted the occurrence of END after intravenous thrombolysis in AIS patients was the highest,and ischemic

关 键 词：急性缺血性脑卒中 大动脉闭塞 侧支循环 CT灌注 

分 类 号：R743.3[医药卫生—神经病学与精神病学]