CT灌注成像结合血清EPA/AA预测脑白质疏松的急性缺血性脑卒中溶栓后出血转化及短期预后的价值  

Value of CT perfusion imaging combined with serum EPA/AA in predicting hemorrhage transformation and short-term prognosis after thrombolysis in acute ischemic stroke with leukoaraiosis

作　　者：熊建 屈战利 任瑜 尹均明 季一飞 XIONG Jian;QU Zhan-li;REN Yu;YIN Jun-ming;JI Yi-fei(Department of Neurology,Nanchong Central Hospital/Second Clinical School of North Sichuan Medical College,Nanchong Sichuan 637000,China)

机构地区：[1]南充市中心医院/川北医学院第二临床医学院神经内科,四川南充637000

出　　处：《局解手术学杂志》2025年第1期32-37,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：四川省自然科学基金(2022NSFSC0756)。

摘　　要：目的 探讨CT灌注成像(CTP)结合血清二十碳五烯酸(EPA)/花生四烯酸(AA)预测脑白质疏松的急性缺血性脑卒中(AIS)患者溶栓后出血转化及短期预后的价值。方法 选取2021年1月至2022年12月我院神经内科收治的合并脑白质疏松的AIS患者98例为研究对象,根据是否发生溶栓后出血转化分为出血转化组及无出血转化组。采用Fazekas量表评估患者脑白质疏松情况。对比2组患者和出血转化组不同程度脑白质疏松患者CTP参数及EPA/AA。采用受试者工作特征(ROC)曲线评估CTP参数及EPA/AA对发生出血转化的预测价值;根据患者溶栓后1个月的改良Rankin量表(mRS)评分评估预后;采用线性及线性组合评估变量间的线性关系;采用ROC曲线评估CTP参数及EPA/AA对患者短期预后的预测价值。结果 出血转化组患者的相对脑血流量(rCBF)、相对脑血容量(rCBV)及CTP整合指数、EPA/AA明显低于无出血转化组(P<0.05),而相对达峰时间(rTTP)明显长于无出血转化组(P<0.05)。随着脑白质疏松程度增加,患者出血转化发生率增加(P<0.05)。在出血转化组患者中,轻度脑白质疏松患者rCBF、rCBV、CTP整合指数及EPA/AA高于中重度脑白质疏松患者(P<0.05)。轻度脑白质疏松患者中,rCBF及EPA/AA预测出血转化的曲线下面积(AUC)分别为0.712、0.720(P<0.05);对于中重度脑白质疏松患者,rCBF、rCBV、rTTP、CTP整合指数、EPA/AA预测出血转化的AUC分别为0.738、0.714、0.717、0.739、0.742(P<0.05)。98例溶栓患者中,35例患者出现预后不良。rCBF、rCBV、CTP整合指数、EPA/AA预测短期预后的AUC分别为0.742、0.732、0.704、0.738,四者联合预测的AUC为0.968。结论 CTP参数及EPA/AA对合并脑白质疏松的AIS患者溶栓后发生出血转化具有一定的预测价值,rCBV、rCBF、CTP整合指数、EPA/AA是影响此类患者短期预后的重要因素。Objective To investigate the value of CT perfusion imaging(CTP) combined with serum eicosapentaenoic acid(EPA)/arachidonic acid(AA) in predicting hemorrhage transformation and short-term prognosis after thrombolysis in acute ischemic stroke(AIS) patients with leukoaraiosis.Methods Ninety-eight AIS patients with leukoaraiosis admitted to the department of neurology of our hospital from January 2021 to December 2022 were selected and divided into the hemorrhage transformation group and non-hemorrhage transformation group according to whether hemorrhage transformation occurred after thrombolysis.The Fazekas scale was used to evaluate the leukoaraiosis of the patients.CTP parameters and EPA/AA were compared between patients in the two groups and patients with different degrees of leukoaraiosis in the hemorrhage transformation group.The predictive value of CTP parameters and EPA/AA on the occurrence of hemorrhage transformation was evaluated by receiver operating characteristic(ROC) curve.The prognosis was assessed according to the modified Rankin scale(mRS) score 1 month after thrombolysis;the linear and linear combinations are used to evaluate the linear relationship between variables;the ROC curve was used to evaluate the predictive value of CTP parameters and EPA/AA in the short-term prognosis of patients.Results The reactive cerebral blood flow(rCBF),reactive cerebral blood volume(rCBV),CTP integration index and EPA/AA in the hemorrhage transformation group were significantly lower than those in the non-hemorrhage transformation group(P<0.05),while the relative time to peak(rTTP) was significantly longer than that in the non-hemorrhage transformation group(P<0.05).The incidence of hemorrhage transformation increased with the increase of leukoaraiosis degree(P<0.05).In the hemorrhage transformation group,rCBF,rCBV,CTP integration index and EPA/AA of patients with mild leukoaraiosis were higher than those of patients with moderate-severe leukoaraiosis(P<0.05).In patients with mild leukoaraiosis,the area under the c

关 键 词：急性缺血性脑卒中 出血转化 脑白质疏松 CT灌注成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]