FVH⁃DWI不匹配及PVS⁃DWI不匹配评估急性脑梗死预后:侧支循环分层研究  

The Value of FVH⁃DWI Mismatch and PVS⁃DWI Mismatch in Evaluating Prognosis of Acute Ischemic Stroke:Based on Collateral Circulation Stratification

作　　者：华蓓 户培华 葛金丹 耿立娜 王勇 全冠民[3] HUA Bei;HU Peihua;GE Jindan(Department of Radiology and Nuclear Medicine,The First Hospital of Hebei Medical University,Shijiazhuang,Hebei Province 050031,P.R.China)

机构地区：[1]河北医科大学第一医院放射与核医学科,石家庄050031 [2]河北医科大学第一医院医务处,石家庄050031 [3]河北医科大学第二医院影像科,石家庄050000

出　　处：《临床放射学杂志》2024年第8期1276-1282,共7页Journal of Clinical Radiology

基　　金：河北省医学科学研究重点课题项目(编号:20231037)。

摘　　要：目的探讨不同侧支循环状态下液体衰减反转恢复序列(FLAIR)血管高信号征(FVH)⁃扩散加权成像(DWI)不匹配及磁敏感加权成像(SWI)突出血管征(PVS)⁃DWI不匹配对急性脑梗死(AIS)预后的评估价值。方法连续纳入87例未接受再灌注治疗的AIS患者。根据改良Rankin量表(mRS)评分将患者分为神经功能预后良好组和不良组,采用卡方检验、t检验及Mann⁃Whitney检验比较两组间指标的差异。根据区域性软脑膜侧支评分(rLMC)将全部患者分为侧支循环不良亚组(rLMC≤10)及良好亚组(rLMC>10)进行分析,采用多因素Logistic回归分析侧支循环亚组中AIS预后的独立预测因子。结果全部患者中rLMC、美国国立卫生研究院卒中量表评分(NIHSS)(入院时及2周后)是AIS的独立预测因子(P均<0.05),而FVH⁃DWI不匹配及PVS⁃DWI不匹配无独立预测价值(P=0.356;P=0.156)。而侧支循环不良亚组分析中,rLMC、FVH⁃DWI不匹配、NIHSS(2周后)是AIS预后的独立预测因子(模型1);rLMC、PVS⁃DWI不匹配是AIS预后的独立预测因子(模型2)。侧支循环良好亚组分析中,仅rLMC、NIHSS(2周后)是AIS预后的独立预测因子(模型3)。结论当FVH⁃DWI不匹配和PVS⁃DWI不匹配评估AIS预后时,应首先考虑侧支循环状态。当侧支循环不良时,FVH⁃DWI不匹配和PVS⁃DWI不匹配可大致评估“缺血半暗带”情况,提示AIS患者预后良好。Objective To explore the value of FLAIR vascular hyperintensity(FVH)⁃diffusion weighted image(DWI)mismatch and prominent vessel sign(PVS)⁃DWI mismatch in evaluating prognosis of acute ischemic stroke(AIS)under different collateral circulation status.Methods Eighty⁃seven cases of consecutive AIS patients without reperfusion treatment were enrolled.All patients were divided into poor and good neurologic function group according to modified Rankin score(mRS).Chi square,t⁃test and Mann⁃Whitney U test was performed to test the differences between the two groups.All patients were divided into subgroup of poor and good collateral circulation according to regional Leptomeningeal Collateral(rLMC).Then the multivariate logistic regression model was set up to determined independent predictors for AIS prognosis in subgroup.Results For all patients,rLMC,NIHSS(on admission and two weeks later)were independent prognostic predictors of AIS(all P<0.05).While,FVH⁃DWI mismatch and PVS⁃DWI mismatch were not independent predictors(P=0.356;P=0.156).For poor collateral circulation subgroup,rLMC,FVH⁃DWI mismatch,and NIHSS(two weeks later)were independent prognostic predictors of AIS(Regression Model 1);rLMC and PVS⁃DWI mismatch were also independent prognostic predictors(Regression Model 2).For good collateral circulation subgroup,rLMC and NIHSS(two weeks later)were independent prognostic predictors(Regression Model 3).Conclusion When FVH⁃DWI mismatch and PVS⁃DWI mismatch are employed for prognosis assessment in AIS patients,the collateral circulation status should be evaluated at first.In those patients with poor collateral circulation,the FVH⁃DWI mismatch and PVS⁃DWI mismatch can rough estimate the existence of ischemic penumbra and indicate good prognosis of AIS.

关 键 词：急性脑梗死 血管高信号征 突出血管征 侧支循环 预后 

分 类 号：R743.33[医药卫生—神经病学与精神病学]