多时相CTA侧支循环评分联合血浆D二聚体和纤维蛋白原比值预测大脑中动脉闭塞急性脑卒中患者预后  

Predictive value of collateral circulation score based on multi-phase CT angiography and plasma D-dimerto fibrinogen ratio in patients with acute ischemic stroke caused by middle cerebral artery occlusion

作　　者：李建东 赵正宇 王梦云 刘红阳 LI Jian-dong;ZHAO Zheng-yu;WANG Meng-yun(Department of Radiology,Huaian Hospital Affiliated to Xuzhou Medical University,Jiangsu 223001,China)

机构地区：[1]徐州医科大学附属淮安医院影像科,江苏淮安223001

出　　处：《放射学实践》2024年第12期1572-1577,共6页Radiologic Practice

摘　　要：目的:探讨多时相CTA侧支循环评分联合血浆D-二聚体与纤维蛋白原(FIB)的比值(D/F)在预测大脑中动脉闭塞急性缺血性脑卒中(AIS)患者预后中的价值。方法:选择2021年10月-2024年4月在本院确诊为大脑中动脉闭塞AIS的102例住院患者作为研究对象,使用Toshiba Aqui-lion ONE 320排螺旋CT机进行头颅CT扫描。根据CT灌注成像原始图像中的动脉期、静脉期和静脉晚期定义多时相CTA。采用CTP脑灌注智能分析系统自动获得核心梗死体积和低灌注体积。采用Menon评分法(0~5分)对多时相CTA上侧支血管的情况进行评分。测量血浆D二聚体和FIB水平,计算两者比值(D/F)。根据治疗后3个月时改良Rankin量表(mRS)评分将患者分为预后良好组(45例)和预后不良组(57例)。采用t或χ^(2)检验对两组患者的一般资料、多时相CTA侧支循环评分、核心梗死体积和低灌注体积进行比较。采用多因素Logistic回归分析影响AIS患者预后的独立危险因素。采用受试者特征曲线(ROC)分析CTA侧支循环评分及对血浆D/F预测大脑中动脉闭塞AIS患者预后的效能结果:相较于预后良好组,预后不良组患者的糖尿病患病比例显著升高(P<0.05),多时相CTA侧支循环评分显著降低(P<0.001)血浆D/F显著升高(P<0.001)。Pearson相关性分析结果显示,AIS患者多时相CTA侧支循环评分与血浆D/F呈显著负相关(r=-0.350,P<0.001)。多时相CTA侧支循环评分和血浆D/F单独预测AIS患者预后不良的AUC分别为0.760(95%CI:0.668~0.851,P<0.001)、0.820(95%CI:0.741~0.899,P<0.001);两者联合时AUC为0.868(95%CI:0.801~0.935,P<0.001),相应的诊断敏感度为82.5%,特异度为77.8%。结论:多时相CTA侧支循环评分联合血浆D二聚体与纤维蛋白原的比值对大脑中动脉闭塞AIS患者的预后具有一定预测价值。Objective:To investigate the value of collateral circulation score based on multi-phase CT angiography(CTA)combined with plasma D-dimer to fibrinogen ratio(D/F)in predicting prognosis of patients with acute ischemic stroke(AIS)caused by middle cerebral artery occlusion.Methods:102 patients diagnosed as middle cerebral artery occlusion AIS in our hospital from October 2021 to April 2024 were selected as the study objects.The Toshiba Aquilion ONE 320-row spiral CT scanner was used to perform head CT scan,and multi-phase CTA was defined based on the cerebral artery phase,cerebral vein phase and cerebral vein late phase in the original images of CT perfusion imaging.The core infarct volume and hypoperfusion volume were obtained automatically by CTP intelligent cerebral perfusion analysis system.Menon score method(0 to 5 points)was used to score the upper collateral vessels of multi-temporal CTA.Plasma D-dimer and FIB levels were measured and the ratio of them(D/F)was calculated.According to the modified Rankin Scale(mRS)score 3 months after treatment,the patients were divided into a good prognosis group(45 cases)and a poor prognosis group(57 cases).The clinical data,multi-phase CTA collateral circulation score,core infarction volume and hypoperfusion volume were compared between the two groups using t-orχ^(2)-test.Multivariate logistic regression analysis was used to analyze the independent risk factors for the prognosis of AIS patients.Receiver operation characteristic curve(ROC)was used to analyze the efficacy of CTA collate-ral circulation score and plasma D/F in predicting the prognosis of AIS patients with middle cerebral artery occlusion.Results:Compared with the good prognosis group,the proportion of diabetes in the poor prognosis group was significantly increased(P<0.05),and the multi-phase CTA collateral circulation score was significantly decreased(P<0.001).Plasma D/F was significantly increased(P<0.001).Pearson correlation analysis showed that there was a significant negative correlation between multi-pha

关 键 词：多时相CT血管成像 侧支循环 D二聚体 纤维蛋白原 急性缺血性脑卒中 大脑中动脉闭塞 

分 类 号：R814.42[医药卫生—影像医学与核医学] R743.33[医药卫生—放射医学]