CT血管成像联合CT灌注成像在急性脑梗死患者取栓后出血转化中的应用价值  

Application value of CT angiography combined with CT perfusion in hemorrhagic transformation in patients with acute cerebral infarction after thrombectomy

作　　者：钟伟[1] 凌维汉[1] 石玉良[1] 张胜 熊波[1] ZHONG Wei;LING Weihan;SHI Yuliang;ZHANG Sheng;XIONG Bo(Department of Neurology,Meizhou People's Hospital,Meizhou,Guangdong 514000,China)

机构地区：[1]梅州市人民医院神经内科,514000

出　　处：《心肺血管病杂志》2025年第2期179-185,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：2023年度梅州市社会发展科技计划项目(2023C0301155)。

摘　　要：目的:CT血管成像(CT angiography,CTA)与CT灌注成像(CT perfusion,CTP)在急性脑梗死患者取栓后出血转化中的应用价值。方法:回顾性分析2021年1月至2024年5月在梅州市人民医院就诊的96例急性脑梗死取栓患者的临床资料进行研究。按照头颅影像学检查结果将7d内是否发生出血转化的患者分为发生组(n=66)与未发生组(n=30)。收集两组患者的一般资料、影像学资料进行单因素分析。应用受试者工作特征曲线分析CTA与CTP参数对急性脑梗死患者取栓后出血转化的预测价值,并使用Logistic逐步回归计算方法将上述有统计学意义参数指标逐步联合后再分析其联合评估的预测价值。对单因素分析有差异变量使用Logistic回归分析探讨急性脑梗死患者取栓后发生出血转化的影响因素。结果:两组患者年龄、入院时血糖、收缩压、合并糖尿病占比,差异有统计学意义(P<0.05)。发生组患者Alberta卒中项目早期CT评分(7.3±0.9)分低于未发生组(8.5±1.6)分,差异有统计学意义(t=4.553,P<0.001)。发生组患者脑血容量、脑血流量低于未发生组,平均通过时间、达峰时间长于未发生组(P<0.05)。应用受试者工作特征曲线分析显示,Alberta卒中项目早期CT评分、脑血容量、脑血流量、平均通过时间、达峰时间以及各指标联合预测急性脑梗死患者取栓后出血转化的曲线下面积分别为0.779、0.685、0.763、0.689、0.681、0.896,具有一定预测价值(P<0.05)。Logistic回归分析显示,入院血糖≥6.9 mmol/L、有糖尿病、Alberta卒中项目早期CT评分≤7.0分、脑血容量≤2.1 mL/100 mL、脑血流量≤17.1 mL/(100 mL·min)、平均通过时间>10.5 s、达峰时间>20.8 s是急性脑梗死患者取栓后发生出血转化的影响因素。结论:CTA+CTP联合检测对急性脑梗死患者取栓后出血转化有重要意义,值得临床推广。Objective:To explore the application value of CT angiography(CTA)and CT perfusion(CTP)in hemorrhagic transformation in patients with acute cerebral infarction after thrombectomy.Methods:A retrospective analysis was performed on the clinical data of 96 patients with acute cerebral infarction who underwent thrombectomy in the hospital between January 2021 and May 2024.According to presence or absence of hemorrhagic transformation within 7d by head imaging examination,patients were divided into occurrence group(n=66)and non-occurrence group(n=30).The general data and imaging data in the two groups were collected for univariate analysis.The predictive value of CTA and CTP parameters for hemorrhagic transformation was analyzed by receiver operating characteristic(ROC)curves.The above parameters and indexes with statistical significance were analyzed by Logistic stepwise regression analysis to analyze predictive value of combined detection.The differential variables in univariate analysis were analyzed by Logistic regression analysis to analyze influencing factors of hemorrhagic transformation in patients with acute cerebral infarction after thrombectomy.Results:There were significant difference in age,blood glucose at admission,systolic blood pressure and proportion of diabetes mellitus between the two groups(P<0.05).The score of Alberta Stroke Project early CT in occurrence group was lower than that in non-occurrence group[(7.3±0.9)vs.(8.5±1.6)points;t=4.553,P<0.001].The cerebral blood volume and cerebral blood flow in occurrence group were lower than those in non-occurrence group,mean transit time and time to peak were longer than those in non-occurrence group(P<0.05).ROC curves analysis showed that area under the curve(AUC)of early CT score,cerebral blood volume,cerebral blood flow,mean transit time,time to peak and combined detection for predicting hemorrhagic transformation were 0.779,0.685,0.763,0.689,0.681 and 0.896,all showing certain predictive value(P<0.05).Logistic regression analysis showed that blood gl

关 键 词：CT血管成像 CT灌注成像 急性脑梗死患者 出血转化 

分 类 号：R54[医药卫生—心血管疾病]