DWI-ASPECTS评分与急性缺血性脑卒中侧支循环建立及介入治疗预后的相关性  

Correlations among DWI-ASPECTS,collateral circulation establishment in acute ischemicstroke and the prognosis of interventional therapy

作　　者：赵月飞 范英超 叶红莲 ZHAO Yuefei;FAN Yingchao;YE Honglian(Dandong Central Hospital,Dandong 118000,China;Air Force Hospital of the Northern Theater of the Chinese People’s Liberation Army,Shenyang 110000,China;Shengjing Hospital Affiliated to China Medical University,Shenyang 110136,China)

机构地区：[1]丹东市中心医院,辽宁丹东118000 [2]中国人民解放军北部战区空军医院,辽宁沈阳110000 [3]中国医科大学附属盛京医院,辽宁沈阳110136

出　　处：《中国实用神经疾病杂志》2024年第12期1573-1578,共6页Chinese Journal of Practical Nervous Diseases

基　　金：2022年度丹东市指导性科技计划项目(编号:2022DDKJ059)。

摘　　要：目的观察弥散加权成像-阿尔伯塔卒中项目早期CT(DWI-ASPECTS)评分与急性缺血性脑卒中(AIS)侧支循环建立及介入治疗预后的相关性。方法回顾性选取2020-01—2023-06丹东市中心医院收治的94例AIS患者临床资料,根据区域软脑膜侧支循环评分(rLMC)分为侧支循环好组与侧支循环差组,比较2组DWI-ASPECTS评分与梗死区域情况,于介入治疗3个月后采用改良Rankin量表(m RS)评分将患者分为预后良好组与预后不良组,比较2组基线资料,并采用受试者工作特征(ROC)曲线分析DWI-ASPECTS评分对预后的预测价值。结果侧支循环好组DWI-ASPECTS评分高于侧支循环差组,NIHSS评分低于侧支循环差组(P<0.05)。Pearson相关性分析显示,r LMC评分与DWI-ASPECTS评分呈正相关(r=0.612),与NIHSS评分呈负相关(r=-0.529,P<0.05)。侧支循环差组患者梗死累及DWI-ASPECTS中I区、M1~M4的比例高于侧支循环好组(P<0.05)。多因素Logistic回归分析显示,年龄、NIHSS评分及DWI-ASPECTS评分是AIS患者预后的独立影响因素(P<0.05)。ROC曲线显示,年龄预测AIS患者预后的最佳截断值为63.50岁,NIHSS评分最佳截断值为11.50分,DWI-ASPECTS评分最佳截断值为7.50分,且DWI-ASPECTS评分预测AIS患者预后的AUC及特异性均高于年龄与NIHSS评分(P<0.05)。结论DWI-ASPECTS评分与AIS患者侧支循环情况密切相关,同时DWI-ASPECTS评分、年龄及NIHSS评分为AIS患者介入治疗预后的独立影响因素,其中DWI-ASPECTS评分对预后具有较高的预测价值,可作为AIS患者介入治疗预后转归的主要预测指标。Objective To observe the correlation among diffusion-weighted imaging-Alberta stroke program early computed tomography score(DWI-ASPECTS),collateral circulation establishment in acute ischemic stroke(AIS)and the prognosis of interventional therapy.Methods The clinical data of 94 patients with AIS admitted to Dandong Central Hospital from January 2020 to June 2023 were retrospectively selected.According to regional leptomeningeal collateral(rLMC)score,the patients were divided into good collateral circulation group and poor collateral circulation group.The DWI-ASPECTS and infarction areas of the two groups were compared.After 3 months of interventional therapy,the patients were divided into the good prognosis group and poor prognosis group according to the modified Rankin scale(mRS)score.The baseline data of the two groups were compared.The prognostic value of DWI-ASPECTS was analyzed using the receiver operating characteristic(ROC)curve.Results The DWI-ASPECTS of good collateral circulation group was higher,and the NIHSS score was lower than that of poor collateral circulation group(P<0.05).Pearson correlation analysis found that the rLMC score was positively correlated with DWI-ASPECTS(r=0.612),and was negatively correlated with the NIHSS score(r=-0.529,P<0.05).The proportion of infarction involving area I and M1-M4 in DWI-ASPECTS was higher in patients with poor collateral circulation than that in patients with good collateral circulation(P<0.05).Multivariate Logistic regression analysis found that age,NIHSS score and DWI-ASPECTS were independent prognostic factors in patients with AIS(P<0.05).ROC curve analysis results showed that the best cut-off values of age,NIHSS score and DWI-ASPECTS for predicting the prognosis of patients with AIS were 63.50 years,11.50 and 7.50.Moreover,the AUC and specificity of DWI-ASPECTS for predicting the prognosis of patients with AIS were higher than those of age and NIHSS score(P<0.05).Conclusion DWI-ASPECTS is closely related to collateral circulation of patients with AIS.DWI-

关 键 词：急性缺血性脑卒中 弥散加权成像-阿尔伯塔卒中项目早期CT评分 侧支循环 介入治疗 预后 影响因素 预测指标 

分 类 号：R743.33[医药卫生—神经病学与精神病学]