低灌注强度比对急性脑卒中血管内治疗后出血性转化风险的预测研究  

Prediction of hemorrhagic transformation(HT)risk after intravascular therapy in acute stroke with hypoperfusion intensity ratio(HIR)

作　　者：赵嘉乐 顿晓熠 王晓蓓 臧哈尔·哈布德勒 哈那提·努尔兰别克 阿布都沙拉穆·孜亚吾丁 孙懿晗 吴勤奋 ZHAO Jiale;DUN Xiaoyi;WANG Xiaobei;Zanghaer Habudele;Hanati Nuerlanbieke;Abdushalamu Ziyawuding;SUN Yihan;WU Qinfen(Xinjiang Medical University,Urumqi 830017,China;The Fifth Affiliated Hospital of Xinjiang Medical University,Key Laboratory of High Incidence Disease Research in Xinjiang,Urumqi 830000,China;The Second Affiliated Hospital of Xinjiang Medical University,Xinjiang Key Laboratory of Neurological Disorder Research,Urumqi 830063,China)

机构地区：[1]新疆医科大学,乌鲁木齐830017 [2]新疆医科大学第五附属医院,新疆地区高发疾病研究教育部重点实验室,乌鲁木齐830000 [3]新疆医科大学第二附属医院,新疆神经系统疾病研究重点实验室,乌鲁木齐830063

出　　处：《新疆医科大学学报》2025年第3期262-267,共6页Journal of Xinjiang Medical University

基　　金：“天山英才”医药卫生高层次人才培养计划项目(TSYC202301A024);新疆医科大学研究生创新创业项目(CXCY2024011)。

摘　　要：目的探讨低灌注强度比值(HIR)在急性缺血性脑卒中(AIS)患者血管内治疗后出血转化(HT)发生风险的预测价值。方法回顾性分析2019年9月-2024年8月在新疆医科大学第二附属医院成功接受血管内治疗(EVT)的194例AIS患者的相关资料,治疗前均接受计算机断层扫描灌注成像(CTP)检查获取CT灌注参数,并采用人工智能分析软件计算HIR。所有患者溶栓后7 d内接受头颅CT动态复查,依据HT发生情况分成出血转化(HT)组(n=61)和非出血转化(non-HT)组(n=133)。采用多因素Logistic分析AIS患者EVT后HT发生的风险因素,利用受试者工作特征(ROC)曲线评价HIR对AIS患者经EVT治疗后发生HT事件的预测效能及最佳预测阈值。结果HT组房颤病史、冠心病史、入院神经功能缺损(NIHSS)评分、核心梗死体积(VrCBF<30%),低灌注体积(VTmax>6 s),严重低灌注体积(VTmax>10 s)、HIR 7项指标高于non-HT组,ASPECTS评分低于non-HT组,差异均有统计学意义(P<0.05)。冠心病史[OR=2.225,95%CI(1.026~4.824)]、入院NIHSS评分[OR=1.300,95%CI(1.180~1.432)]、ASPECTS评分[OR=0.651,95%CI(0.530~0.799)]、VrCBF<30%[OR=1.023,95%CI(1.012~1.035)]、VTmax>10 s[OR=1.015,95%CI(1.008~1.022)]和HIR[OR=2.020,95%CI(1.598~2.553)]是AIS患者EVT后发生HT的独立危险因素(P<0.05)。入院NIHSS评分、VrCBF<30%、VTmax>10 s和HIR预测EVT后HT发生的曲线下面积(AUC)为0.72、0.73、0.74、0.80,HIR的AUC明显大于入院NIHSS评分、VrCBF<30%及VTmax>10 s的AUC(P<0.05),截断值为0.40。结论CT灌注参数HIR与AIS患者EVT后HT发生紧密相关,对AIS患者EVT后HT发生具有一定的预测价值。Objective To investigate the predictive value of hypoperfusion intensity ratio(HIR)in the risk of hemorrhagic transformation(HT)after endovascular treatment in patients with acute ischemic stroke(AIS).Methods The relevant data of 194 patients with acute ischemic stroke(AIS)who successfully received endovascular therapy(EVT)at the hospital from September 2019 to August 2024 were retrospectively analyzed,and all of them underwent computed tomography perfusion imaging(CTP)examination to obtain the CT perfusion parameters before the treatment and use artificial intelligence analysis software to calculate HIR.All patients received cranial CT dynamic review within 7 d after thrombolysis,and the patientswere divided into hemorrhagic transformation(HT)group(n=61)and non-hemorrhagic transformation(non-HT)group(n=133)according to the occurrence of HT.The risk factors of HT occurrence after EVT in AIS patients were analyzed by multifactorial Logistic analysis,and the predictive efficacy and optimal prediction threshold of HIR for HT events after EVT in AIS patients were evaluated by using the subject's work characteristics(ROC)curve.Results The 7 indexes of atrial fibrillation history,coronary heart disease history,admission neurological deficit(NIHSS)score,VrCBF<30%,VTmax>6 s,VTmax>10 s and HIR were higher in the HT group than in the non-HT group,and the ASPECTS score was lower than that of the non-HT group,and the differences were statistically significant(P<0.05).History of coronary heart disease[OR=2.225,95%CI(1.026~4.824)],admission NIHSS score[OR=1.300,95%CI(1.180~1.432)],ASPECTS score[OR=0.651,95%CI(0.530~0.799)],VrCBF<30%[OR=1.023,95%CI(1.012~1.035)],VTmax>10 s[OR=1.015,95%CI(1.008~1.022)]and HIR[OR=2.020,95%CI(1.598~2.553)]were independent risk factors for the development of HT after EVT in patients with AIS(P<0.05).The area under the curve(AUC)of admission NIHSS score,VrCBF<30%,VTmax>10 s and HIR for predicting the occurrence of HT after EVT were 0.72,0.73,0.74 and 0.80,and the AUC of HIR was significantly greater

关 键 词：急性缺血性脑卒中 血管内治疗 出血转化 低灌注强度比值 

分 类 号：R743.3[医药卫生—神经病学与精神病学]