CT灌注成像联合血清生物标志物与穿支动脉粥样硬化病患者预后的相关性研究  

Correlation of CT perfusion imaging parameters combined with serum biomarkers and prognosis in patients with BAD

作　　者：胡胜洁 付胜奇 李浩然 朱利利 禹萌 秦海强[2] Hu Shengjie;Fu Shengqi;Li Haoran;Zhu Lili;Yu Meng;Qin Haiqiang(Department of Neurology,the Fifth Clinical Medical College of Henan University of Chinese Medicine Zhengzhou People's Hospital,Zhengzhou 450003,Henan Province,China)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)神经内科,450003 [2]首都医科大学附属北京天坛医院神经病学中心

出　　处：《中华老年心脑血管病杂志》2025年第3期317-321,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省科技发展计划项目(242102310048)。

摘　　要：目的探讨CT灌注成像联合血清可溶性尿激酶纤溶酶原激活物受体(soluble urokinase plasminogen activator receptor,suPAR)、Mac-2结合蛋白(Mac-2 binding protein,Mac-2BP)与穿支动脉粥样硬化病(branch atheromatous disease,BAD)患者早期神经功能恶化(early neurological deterioration,END)及转归不良的相关性。方法前瞻性纳入2019年6月至2024年3月郑州人民医院神经内科就诊的BAD患者176例,根据发病后72 h是否发生END分为END组42例和非END组134例。随访90 d,按转归情况将患者分为转归良好组129例和转归不良组47例。比较END与非END组及不同临床转归患者血清suPAR、Mac-2BP水平,用ROC曲线分析血清suPAR、Mac-2BP预测END、转归不良的准确性。结果END组suPAR、Mac-2BP、平均通过时间(mean transit time,MTT)、达峰时间(time to peak,TTP)、深部脑白质高信号评分、基底节区EPVS评分及脑灌注受损患者比例显著高于非END组,脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)显著低于非END组(P<0.05,P<0.01)。转归不良组suPAR、Mac-2BP、END时美国国立卫生研究院卒中量表评分、MTT、TTP、基底节区扩大的血管周围间隙评分、END及脑灌注受损患者比例显著高于转归良好组,CBV、CBF显著低于转归良好组(P<0.05,P<0.01)。suPAR、Mac-2BP、脑灌注受损和深部脑白质高信号是END的独立危险因素(P<0.05,P<0.01)。suPAR、Mac-2BP、END时美国国立卫生研究院卒中量表评分、END、脑灌注受损和基底节区扩大的血管周围间隙是转归不良的独立危险因素(P<0.05,P<0.01)。血清suPAR、Mac-2BP联合检测预测BAD患者END的ROC曲线下面积为0.8844(95%CI:0.822~0.947),联合检测预测BAD患者转归不良的ROC曲线下面积为0.8742(95%CI:0.810~0.938)。结论脑灌注受损和suPAR、Mac-2BP是BAD患者发生END及90 d时转归不良的独立危险因素,联合检测有助于病情及预后评估。Objective To investigate the correlation of imaging parameters of CT perfusion scanning combined with serum suPAR and Mac-2BP with END and poor outcomes in patients with BAD.Methods A total of 176 BAD patients admitted to Department of Neurology of Zhengzhou People's Hospital from June 2019 to March 2024 were prospectively enrolled,and according to whether END occurred within 72 h after onset,they were divided into END group(42 cases)and non-END group(134 cases).Based on their outcomes at 90 d of follow-up,they were also assigned into good outcome group(129 cases)and poor outcome group(47 cases).The serum suPAR and Mac-2BP levels were compared between the END and non-END groups,as well as the good and poor outcome groups.ROC curves were plotted to analyze the accuracies of serum suPAR and Mac-2BP in predicting END and poor outcomes.Results The END group had significantly higher suPAR and Mac-2BP levels,longer MTT and TTP,and larger proportions of DWMH,basal ganglia EPVS and cerebral perfusion impairment,but lower CBV and CBF when compared with the non-END group(P<0.05,P<0.01).Obviously higher suPAR and Mac-2BP levels,NIHSS score at END,longer MTT and TTP,and larger proportions of EDN,basal ganglia EPVS and cerebral perfusion impairment,but lower CBV and CBF were observed in the poor outcome group than the good outcome group(P<0.05,P<0.01).suPAR and Mac-2BP levels,cerebral perfusion impairment and DWMH were independent risk factors for END(P<0.05,P<0.01).suPAR,Mac-2BP,NIHSS score at END,END,cerebral perfusion impairment,and basal ganglia EPVS were independent risk factors for poor outcomes(P<0.05,P<0.01).The AUC value of combined suPAR and Mac-2BP in predicting END was 0.8844(95%CI:0.822-0.947),and the value in predicting poor outcomes was 0.8742(95%CI:0.810-0.938)in BAD patients.Conclusion Cerebral perfusion impairment,suPAR and Mac-2BP are independent risk factors for END and poor outcome at 90 d in BAD patients.Combined detection can is helpful in evaluating the patient's condition and predicting the prognosis.

关 键 词：灌注成像 脑血管循环 动脉粥样硬化 预后 

分 类 号：R543.5[医药卫生—心血管疾病] R816.2[医药卫生—内科学]