经颅多普勒超声脑血流参数联合检测对急性脑梗死出血性转化的预测价值  

Value of Transcranial Doppler Ultrasound Combined Detection of Cerebral Blood Flow Parameters in Predicting Hemorrhagic Transformation in Acute Cerebral Infarction

作　　者：王文荣 蕙品晶 WANG Wenrong;HUI Pinjing(Department of Cervical Cerebrovascular Ultrasound,First Affiliated Hospital of Soochow University,Jiangsu 215008,China)

机构地区：[1]苏州大学附属第一医院颈脑血管超声科,江苏215008

出　　处：《影像科学与光化学》2025年第2期73-81,146,共10页Imaging Science and Photochemistry

基　　金：苏州市民生科技项目(SS202061);苏州大学技术合作项目(H211064)。

摘　　要：目的:探讨经颅多普勒超声(TCD)脑血流参数在预测急性脑梗死(ACI)患者出血性转化(HT)中的应用价值。方法:选取2020年1月至2023年8月本院收治的145例ACI患者,采用TCD检测大脑中动脉的收缩期峰值流速(Vs)、舒张期峰值流速(Vd)、平均血流速(Vm)和搏动指数(PI),采用CT灌注成像检测脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和达峰时间(TTP)。记录30天内HT的发生情况,并通过Logistic回归模型分析影响因素。结果:HT的发生率为45.32%。发生组的Vs、Vd、Vm显著低于未发生组(P<0.05),而PI显著高于未发生组(P<0.05);发生组的CBF低于未发生组(P<0.05),MTT长于未发生组(P<0.05);两组的CBV、TTP比较,差异均无统计学意义(P>0.05);Logistic回归分析显示,高脂血症史、房颤史、入院时NIHSS评分、脑白质疏松、Vm、PI和CBF是ACI患者发生HT的独立影响因素(P<0.05)。ROC曲线分析表明,Vm和PI联合预测ACI患者发生HT的AUC为0.911,灵敏度为92.06%,特异度为78.67%。结论:TCD脑血流参数,特别是Vm和PI,对于预测ACI患者的出血性转化具有重要的临床价值,有助于早期识别高风险患者并指导临床决策。Objective:To investigate the application value of transcranial Doppler ultrasound(TCD)cerebral blood flow parameters in predicting hemorrhagic transformation(HT)in patients with acute cerebral infarction(ACI).Methods:One hundred and forty⁃five patients with ACI admitted to our hospital from January 2020 to August 2023 were selected,and the peak systolic flow velocity(Vs),peak diastolic flow velocity(Vd),mean blood flow velocity(Vm)and pulse index(PI)of middle cerebral artery were detected by TCD.The cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)and time to peak(TTP)were detected by CT perfusion imaging.The occurrence of HT within 30 days was recorded,and the influencing factors were analyzed by Logistic regression model.Results:The incidence of HT was 45.32%.The Vs,Vd and Vm in the occurrence group were significantly lower than those in the non⁃occurrence group(P<0.05),while the PI was significantly higher than that in the non⁃occurrence group(P<0.05).The CBF in the occurrence group was lower than that in the non⁃occurrence group(P<0.05),and the MTT was longer than that in the non⁃occurrence group(P<0.05).There were no significant differences in CBV and TTP between the two groups(P>0.05).Logistic regression analysis showed that history of hyperlipidemia,history of atrial fibrillation,NIHSS score at admission,leucooporosis,Vm,PI and CBF were independent influencing factors for HT in ACI patients(P<0.05).ROC curve analysis showed that the AUC of Vm and PI combined to predict HT in ACI patients was 0.911,the sensitivity was 92.06%,and the specificity was 78.67%.Conclusion:TCD cerebral blood flow parameters,especially Vm and PI,have important clinical value in predicting hemorrhagic transformation in ACI patients,helping to identify high⁃risk patients early and guide clinical decision⁃making.

关 键 词：经颅多普勒超声 脑血流动力学 急性脑梗死 出血性转化预测 LOGISTIC回归分析 

分 类 号：R743.3[医药卫生—神经病学与精神病学]