灌注CT微血管通透性对缺血性脑卒中患者出血性转化的预测

Microvascular permeability detected by perfusion CT predicts hemorrhagic transformation in ischemic stroke patients

目的探讨灌注CT微血管通透性(PS)对缺血性脑卒中患者静脉溶栓治疗后出血性转化的预测效果。方法回顾性选择80例在我院诊断为缺血性脑卒中行静脉溶栓治疗的患者为研究对象,根据其治疗后是否发生出血性转化分为出血组38例与未出血组42例。所有患者均行头颅CT检查,评价灌注CT参数对缺血性脑卒中患者出血性转化的预测价值。结果 80例缺血性脑卒中静脉溶栓患者47.5%发生出血性转化。出血组患者平均年龄、美国国立卫生研究院卒中量表评分及大面积脑梗死比例明显高于未出血组[(73.2±5.0)岁vs(66.2±4.7)岁、(15.4±2.6)分vs(9.1±1.3)分及34.2%vs 14.3%,P<0.05]。出血组PS明显高于未出血组,差异有统计学意义(P=0.000)。PS曲线下面积为0.924,诊断界值为5.86ml/(min·100g),敏感性为94.7%,特异性为88.1%,阳性似然比为0.88,阴性似然为比0.95。结论 PS值对缺血性脑卒中患者静脉溶栓后出血性转化有较好的预测价值,PS值>5.86ml/(min·100g)时出血性转化的风险明显提高,可作为临床静脉溶栓的应用依据。

Objective To study the role of microvascular permeability detected by perfusion CT in predicting hemorrhagic transformation in ischemic stroke patients.Methods Eighty ischemic stroke patients after thrombolytic therapy were divided into hemorrhagic group（n=38）and nonhemorrhagic group（n=42）.The patients underwent cranial CT scan.The role of perfusion CT parameters in predicting their hemorrhagic transformation was assessed.Results The incidence of hemorrhagic transformation was 47.5%in the 80 ischemic stroke patients.The age was older,the NIHSS score was higher,and the ischemic stroke size was larger in hemorrhagic group than in non-hemorrhagic group（73.2±5.0years vs 66.2±4.7years,15.4±2.6 vs 9.1±1.3,34.2% vs14.3%,P0.05）.The microvascular permeability detected by perfusion CT was significantly higher in hemorrhagic group than in non-hemorrhagic group（P0.05）.The area under the microvascular permeability curve for perfusion CT was 0.924,with a diagnostic value of 5.86 ml/（min·100g）,a sensitivity of 94.7%,a specificity of 88.1%,apositive likelihood ratio of 0.88,and a negative likelihood ratio of 0.95.Conclusion Microvascular permeability detected by perfusion CT plays an important role in predicting hemorrhagic transformation in ischemic stroke patients after thrombolytic therapy.The risk to develop hemorrhagic transformation is high when the microvascular permeability detected perfusion CT is5.86ml/（min·100g）.