基于ASPECTS分区的烟雾病CT灌注与DSA侧支代偿的相关性研究  

A Study on the Correlation between ASPECTS-Based CT Perfusion and DSA Collateral Compensation in Moyamoya Disease

作　　者：杜海斌 孙剑 刘炜 张东 DU Haibin;SUN Jian;LIU Wei;ZHANG Dong(Department of Neurosurgery,Beijing Changping Hospital,Beijing 102200,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京市昌平区医院神经外科,北京102200 [2]首都医科大学附属北京天坛医院神经外科 [3]北京医院神经外科,国家老年医学中心,中国医学科学院老年医学研究院

出　　处：《中国卒中杂志》2024年第7期755-761,共7页Chinese Journal of Stroke

基　　金：国家重点研发计划项目(2021YFC2500502)。

摘　　要：目的探讨烟雾病患者CT灌注和DSA侧支代偿之间的相关性以及影响其大脑半球灌注的危险因素。方法研究纳入115例成年烟雾病患者,共230个大脑半球,收集其DSA和CT灌注数据。ASPECTS分区用于划分大脑区域,对达峰时间(time to peak,TTP)、平均通过时间(mean transit time,MTT)、脑血流量(cerebral blood flow,CBF)和脑血容量(cerebral blood volume,CBV)这4项灌注血流动力学指标进行评分,并对DSA显示的脑血管侧支代偿进行评分。对4项CT灌注血流动力学指标和DSA侧支代偿评分进行Spearman相关分析和多元线性回归分析。结果在115例烟雾病患者中,MTT评分(r=0.41,P<0.01)与DSA侧支代偿评分呈正相关。DSA侧支代偿评分(β=0.31,P=0.02)、性别(β=1.20,P=0.01)、临床分型(β=2.94,P<0.01)和卒中史(β=-1.19,P=0.02)是脑灌注改变的独立影响因素,女性患者的灌注优于男性患者(P=0.02),出血性患者的灌注优于缺血性患者(P=0.01),无卒中史的患者灌注优于有卒中史的患者(P=0.03)。结论DSA侧支代偿评分与MTT评分相关。DSA侧支代偿评分、性别、临床分型和卒中史是大脑半球灌注的独立影响因素。在评估旁路血管、新血管形成和术后预后时需要注意CT灌注。Objective To explore the correlation between CT perfusion and DSA collateral compensation and the risk factors affecting cerebral hemisphere perfusion in patients with Moyamoya disease.Methods A total of 115 adult Moyamoya disease patients with 230 cerebral hemispheres were enrolled in this study,and their DSA and CT perfusion data were collected.The ASPECTS was used to divide the brain regions and score four perfusion hemodynamic indicators including time to peak(TTP),mean transit time(MTT),cerebral blood flow(CBF),and cerebral blood volume(CBV),and to score the cerebrovascular collateral compensation displayed by DSA.Spearman correlation analysis and multiple linear regression analysis were performed on the four perfusion hemodynamic indicators and the DSA collateral compensation score.Results In 115 patients with Moyamoya disease,MTT score(r=0.41,P<0.01)was positively correlated with the DSA collateral compensation score.The DSA collateral compensation score(β=0.31,P=0.02),gender(β=1.20,P=0.01),clinical type(β=2.94,P<0.01),and history of stroke(β=-1.19,P=0.02)were independent influencing factors for cerebral perfusion changes.Female patients had better perfusion than male patients(P=0.02),hemorrhagic patients had better perfusion than ischemic patients(P=0.01),and patients without a history of stroke had better perfusion than those with a history of stroke(P=0.03).Conclusions The DSA collateral compensation score was correlated with the MTT score.Moreover,the DSA collateral compensation score,gender,clinical type,and history of stroke were independent influencing factors for cerebral hemisphere perfusion.CT perfusion should be considered when evaluating bypass vessels,neovascularization,and postoperative prognosis.

关 键 词：烟雾病 计算机断层扫描灌注 侧支代偿 

分 类 号：R74[医药卫生—神经病学与精神病学]