基于多模态MRI构建侧支循环评分对急性缺血性脑卒中溶栓治疗结局转归的预测价值  

Predictive value of collateral circulation score based on multimodal MRI on the outcome of thrombolytic therapy for acute ischemic stroke

作　　者：何林 任义财 李旭雪 宋世强 蒋晓兰[1] HE Lin;REN Yicai;LI Xuxue;SONG Shiqiang;JIANG Xiaolan(Sichuan Integrative Medicine Hospital,Chengdu 610042,China;Sichuan Orthopedic Hospital,Chengdu 610041,China)

机构地区：[1]四川省中西医结合医院,四川成都610042 [2]四川省骨科医院,四川成都610041

出　　处：《中国实用神经疾病杂志》2025年第4期421-426,共6页Chinese Journal of Practical Nervous Diseases

基　　金：四川省中国医药管理局科学技术研究专项课题(编号:2020LC0174)。

摘　　要：目的基于多模态磁共振成像(MRI)构建侧支循环评分,探讨其对急性缺血性脑卒中患者溶栓治疗结局转归的预测价值。方法选取2021-05—2022-12接受溶栓治疗的116例急性缺血性脑卒中患者为研究对象,根据患者的溶栓治疗结局转归分为转归良好组和转归不良组,收集患者的一般资料及多模态MRI图像,根据多模态MRI图像构建侧支循环评分,采用多因素Logistic回归分析影响急性缺血性脑卒中患者溶栓治疗结局转归的相关因素,通过ROC曲线分析基于多模态MRI构建侧支循环评分对患者治疗结局的预测价值。结果随访过程中3例患者死亡,8例缺血性脑卒中复发,7例发生出血性脑卒中,26例出现神经功能恶化,32例mRS评分>2分,最终转归不良组纳入47例患者,转归良好组纳入69例患者。转归不良组rCBF、rCBV及侧支循环评分均低于转归良好组,MTT、TTP高于转归良好组(P<0.05)。多因素Logistic回归分析显示,TTP(OR=0.778)、侧支循环评分(OR=1.805)是影响溶栓治疗结局转归的独立危险因素(均P<0.05)。ROC曲线显示侧支循环评分的AUC为0.970,敏感性92.75%,特异性91.49%。结论侧支循环状况与急性缺血性脑卒中患者的预后密切相关,基于多模态MRI构建的侧支循环评分有助于预测急性缺血性脑卒中患者溶栓治疗结局转归。Objective To construct collateral circulation score based on MRI,and investigate its predictive value for the outcome of thrombolytic therapy in patients with acute ischemic stroke.Methods Totally 116 patients with acute ischemic stroke who received thrombolytic therapy from May 2021 to December 2022 were selected as the research objects.According to the outcome of thrombolytic therapy,they were divided into good outcome group and poor outcome group.The general data of patients and their multimodal MRI images were collected,and the collateral circulation score was constructed according to the multimodal MRI images.Multivariate Logistic regression was used to analyze the related factors affecting the outcome of thrombolytic therapy for patients with acute ischemic stroke,and ROC curve was used to analyze the outcome of the treatment based on multimodal MRI.Results During the follow-up,3 patients died,8 patients had ischemic stroke recurrence,7 patients had hemorrhagic stroke,26 patients had neurological deterioration,and 32 patients had mRS>2.Finally,47 patients were included in the poor prognosis group and 69 patients were included in the good prognosis group.The scores of rCBF,rCBV and collateral circulation in the good prognosis group were lower than those in the good prognosis group,while MTT and TTP were higher than those in the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that TTP(OR=0.778)and collateral circulation score(OR=1.805)were independent factors affecting the outcome of thrombolytic therapy(P<0.05).ROC curve showed that the AUC of collateral circulation score was 0.970,the sensitivity was 92.75%,and the specificity was 91.49%.Conclusion The condition of collateral circulation is closely related to the prognosis of patients with acute ischemic stroke.The collateral circulation score based on multimodal MRI is helpful to predict the outcome of thrombolytic therapy in patients with acute ischemic stroke.

关 键 词：急性缺血性脑卒中 神经功能恶化 静脉溶栓 多模态磁共振成像 转归结局 

分 类 号：R743.33[医药卫生—神经病学与精神病学]