CT灌注成像参数及血栓弹力图对急性前循环脑梗死早期神经功能恶化的预测价值分析  

Predictive value of CT perfusion imaging parameters and thromboelogram for early neurological deterioration of acute anterior circulatory cerebral infarction

作　　者：李刚 潘晓帆 田雪 刘路路 Gang Li;Xiaofan Pan;Xue Tian;LuLu Liu(Department of Neurology,Wuxi Huishan District People's Hospital(Affiliated Huishan Hospital of Xinglin College,Nantong University),Wuxi 241000,China)

机构地区：[1]无锡市惠山区人民医院(南通大学杏林学院附属惠山医院)神经内科,江苏无锡241000

出　　处：《中华神经创伤外科电子杂志》2024年第4期226-232,共7页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：无锡市卫生健康委面上科研项目(M202232)

摘　　要：目的探讨CT灌注成像(CTP)参数及血栓弹力图(TEG)对急性前循环脑梗死早期神经功能恶化(END)的预测价值。方法选取无锡市惠山区人民医院神经内科自2021年2月至2023年2月收治的149例急性前循环脑梗死患者为研究对象。按照入院3 d内是否发生END将患者分为END组和无END组,比较2组患者美国国立卫生研究院卒中量表(NIHSS)评分、缺血区达峰时间(TTP)、脑血容量(CBV)、脑血流量(CBF)、动力时间(KT)、反应时间(RT);比较不同脑卒中病因的CTP参数和TEG参数。采用Pearson法分析NIHSS评分与CBV、TTP、CBF、RT、KT的相关性;采用多因素二元Logistic回归模型分析急性前循环脑梗死患者END的独立影响因素;建立ROC曲线分析CTP、TEG相关指标的预测效能。结果149例患者中,END组26例,无END组123例,2组患者的NIHSS评分比较,差异有统计学意义(P<0.05)。END组患者的缺血区TTP、CBV、CBF均高于无END组,KT、RT均少于无END组,差异均有统计学意义(P<0.05)。经Pearson法分析,NIHSS评分与TTP、CBV、CBF呈正相关,与RT呈负相关(P<0.05)。二元Logistic回归模型分析显示,TTP、CBV、CBF、KT、RT是急性前循环脑梗死患者END的独立影响因素。ROC曲线分析显示,TTP、CBV、CBF、KT、RT及5项指标联合预测急性前循环脑梗死患者END的AUC分别为0.759、0.694、0.758、0.736、0.794、0.965。5项指标联合的AUC分别与TTP、CBV、CBF、KT、RT的AUC比较,差异均有统计学意义(P<0.05)。结论CTP、TEG能够有效预测急性前循环脑梗死患者END,对改善预后有一定价值。Objective To explore the predictive value of CT perfusion imaging(CTP)parameters and thromboelogram(TEG)for early neurological deterioration(END)in acute anterior circulation cerebral infarction.Methods A total of 149 patients with acute anterior circulation cerebral infarction admitted to Neurology Department of Wuxi Huishan District People&apos;s Hospital from February 2021 to February 2023 were selected as the research subjects.Patients were divided into END group and non END group based on whether END occurred within 3 d of admission.The National Institutes of Health stroke scale(NIHSS)scores,time to peak ischemic zone(TTP),cerebral blood volume(CBV),cerebral blood flow(CBF),dynamic time(KT),and reaction time(RT)were compared between the two groups;CTP parameters and thromboelogram parameters for different causes of stroke were compared.Pearson method was used to analyze the correlation between NIHSS score and CBV,TTP,CBF,RT,KT;The multi factor binary Logistic regression model was used to analyze the independent influencing factors of END in patients with acute anterior circulation cerebral infarction;ROC curve was established to analyze the predictive performance of CTP and TEG related indicators.Results Among the 149 patients,there were 26 patients in the END group and 123 patients in the non END group.The difference in NIHSS scores between the two groups was statistically significant(P<0.05).The TTP,CBV,and CBF in the ischemic area of patients in the END group were higher than those in the non END group,while KT and RT were lower than those in the non END group,and the differences were statistically significant(P<0.05).According to Pearson analysis,NIHSS score was positively correlated with TTP,CBV,and CBF,and negatively correlated with RT(P<0.05).The binary Logistic regression model analysis showed that TTP,CBV,CBF,KT,and RT were independent influencing factors of END in patients with acute anterior circulation cerebral infarction.ROC curve analysis showed that the AUC of TTP,CBV,CBF,KT,RT,and their combi

关 键 词：前循环脑梗死 早期神经功能恶化 CT灌注成像 血栓弹力图 预测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]