CT灌注成像参数对急性脑梗死阿替普酶溶栓后远隔部位脑出血的预测价值  

Predictive value of CT perfusion imaging parameters for remote cerebral hemorrhage after alteplase thrombolysis in acute cerebral infarction

作　　者：王广军 纵锋 张亚奇 程建 石瑜 Wang Guangjun;Zong Feng;Zhang Yaqi(Department of Neurology,the Third People's Hospital of Xuzhou;Department of Neurology,Kuitun Hospital of Yili,Yili Xinjiang 833200)

机构地区：[1]新疆伊犁州奎屯医院神经内科,833200 [2]徐州市第三人民医院神经内科 [3]江苏省徐州市新健康医院神经内科

出　　处：《卒中与神经疾病》2024年第4期341-348,共8页Stroke and Nervous Diseases

基　　金：新疆神经系统疾病研究重点实验室开放课题(课题编号为XJDX1711-2267)。

摘　　要：目的探究计算机X线断层扫描灌注成像(Computed tomography perfusion imaging,CTP)参数对急性脑梗死(Acute cerebral infarct,ACI)阿替普酶溶栓后远隔部位脑出血(Remote intracerebral hemorrhage,rICH)的预测价值。方法选取本院于2020年1月-2022年11月收治的184例ACI患者作为研究对象,以2∶1的比例将患者随机分为训练集(n=122)和验证集(n=62),根据患者阿替普酶溶栓7 d后远隔部位是否发生脑出血分为出血组(n=50)和未出血组(n=72),对比分析2组患者临床资料以及CTP参数;分析CTP不同参数对溶栓后rICH的预测价值,多因素分析影响rICH的危险因素,构建风险预测模型并验证。结果2组患者在相对脑血容量(Relative cerebral blood volume,rCBV)、相对脑血流量(Relative cerebral blood flow,rCBF)、相对达峰时间(Relative time to peak,rTTP)上差异显著(P<0.05);2组患者血脂情况、Trial of ORG 10172 in acute stroke treatment(TOAST)分型、梗死面积、美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评分、D-二聚体(D-dimer,D-D)、金属基质蛋白酶-9(Metalloproteinase-9,MMP-9)、纤维蛋白原(Fibrinogen,FiB)、血小板(Blood platelet,PLT)水平均有明显差异(P<0.05)。CTP不同参数对rICH的诊断效能均较高,其中rCBV诊断效能最高。Logistic回归分析显示影响ACI患者发生rICH的危险因素为rCBV,rCBF,rTTP,NIHSS评分和D-D水平,其中CTP参数联合NIHSS评分、D-D水平对rICH的预测价值最高,曲线下面积(Area under curves,AUC)值最大为0.953,敏感度和特异度分别为95.43%和90.55%。结论CTP不同参数对溶栓后远隔部位脑出血均具有较好的诊断效能,但是在此基础上CTP参数联合NIHSS评分、D-D水平对溶栓后远隔部位脑出血的预测价值最高。Objective To investigate the predictive value of CT perfusion imaging parameters(CTP)for remote intracerebral hemorrhage(rICH)after alteplase thrombolysis in acute cerebral infarction.Methods A total of 184 patients with acute cerebral infarction admitted to our hospital from January 2020 to November 2022 were selected as the study objects.Patients were randomly divided into a training set(n=122)and a verification set(n=62)in a ratio of 2∶1.According to whether cerebral hemorrhage occurred at the remote site 7 days after alteplase thrombilysis,patients were divided into a hemorrhage group(n=50)and a non-hemorrhage group(n=72).Clinical data and CTP parameters of patients in the two groups were compared and analyzed.The predictive value of different parameters of CTP to rICH after thrombolysis was analyzed,and the risk factors affecting rICH were analyzed by multi-factor regression,then a risk prediction model was built and verified.Results There were significant differences in relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF)and relative peak time(rTTP)between the two groups(P<0.05).There were significant differences in blood lipid status,TOAST classification,infarct size,NIHSS score,D-D,MMP-9,FiB and PLT between the two groups(P<0.05).Different parameters of CTP have higher diagnostic efficiency for rICH,among which rCBV has the highest diagnostic efficiency.Logistic regression analysis showed that the risk factors affecting the occurrence of rICH in ACI patients were rCBV,rCBF,rTTP,NIHSS score and D-D,among which CTP parameter combined with NIHSS score and D-D had the highest predictive value for rICH,and the maximum AUC value was 0.953.Sensitivity and specificity were 95.43%and 90.55%,respectively.Conclusion Different parameters of CTP have good diagnostic efficacy for remote cerebral hemorrhage after thrombolysis,but on this basis,CTP parameters combined with NIHSS score and D-D have the highest predictive value for remote cerebral hemorrhage after thrombolysis.

关 键 词：计算机X线断层扫描灌注成像 急性脑梗死 阿替普酶 溶栓 远隔部位脑出血 

分 类 号：R743.3[医药卫生—神经病学与精神病学]