CTA示大脑内静脉不对称与急性前循环缺血性脑卒中患者功能康复的关系

The relation of asymmetry of internal cerebral veins in CTA and functional outcome after acute ischemic stroke

【目的】探讨CT血管造影（CTA）时大脑内静脉（ICV）不对称显影与急性缺血性脑卒中（AIS）患者功能康复情况的关系。【方法】回顾性分析98例AIS并行静脉组织纤维蛋白溶酶原激活物（tPA）溶栓治疗患者的临床资料。患者tPA溶栓3个月后采用改良Rankin量表进行评分，按得分高低分为康复较好组和康复较差组，对比两组患者的年龄、性别、吸烟、高血压、糖尿病等与血管疾病相关的危险因素，以及两组NIHSS评分和溶栓后的CTA影像资料是否有统计学差异，并采用多因素分析其中的独立危险因素。比较CTA影像、NIHSS评分及CTA＋NIHSS评分对患者康复情况评估的特异性、敏感性。【结果】康复较差组患者的平均年龄高于康复较好组、溶栓前NIHSs评分更高、卒中发作24h后NIHSS评分变化更小、溶栓后d2双侧ICV不对称例数更多，差异均有统计学意义（均P〈0．05）。tPA治疗前高NIHSS评分（P=0．041）、24h内NIHSS评分变化，J、（P=0．027）及d2双侧ICV不对称比例多（P=0．031）是预示溶栓后康复较差的独立危险因素。CTA评估的敏感性为83％，高于NIHSS的72％；NIHSS评分的特异性为79％，高于CTA的75％；CTA联合NIHSS评估的特异性和敏感性分别为87％和92％，较单独采用CTA或NIHSS评估的特异性敏感性更高，但差异均没有统计学意义（均P〈0．05）。【结论】AIS患者溶栓后d2双侧ICV不对称较多可以作为预测AIS患者溶栓治疗康复较差的指标，且CTA影像结合NIHSS评分进一步提高了患者康复情况预测的准确度。

[Objective]To investigate the relation between asymmetric development in ICV （Internal cerebral vein, ICV） with CTA （computed tomographic angiography, CTA） and functional outcome after acute ischemic stroke.[Methods]AIS （Acute isehemia stroke, AIS） patients treated with intravenous thrombolysis were included. The presence of ICV asymmetry in CTA was evaluated on day 2 in tPA （tissue plasminogen activator,tPA）-treated AIS patients. National Institutes of Health Stroke Scale （NIHSS） scores were evaluated just before tPA bolus and then 24 hours after the onset of stroke. Functional outcome was assessed by the modified Rankin Scale （mRS） at 3 months, dichotomized as good group and poor proup. Data were analyzed for predictors of functional outcome. [Results]Factors associated with poor outcomes on univariable analyses were higher age, higher NIHSS score at presentation, lower change in NIHSS score during first 24 hours, ICV asymmetry on day 2 CTA, and ICV asym- metry index on day 2 CTA. Poor functional outcome at 3 months was independently associated with higher admis- sion NIHSS score （P=0.041）, change in NIHSS score during first 24 hours （P=0.027）, and ICV asymmetry on follow-up CTA（P=0.031）. The sensitivity assessment of CTA was 83%, higher than that of NIHSS; the speci- ficity of NIHSS score was 79%, higher than that of CTA; CTA combined with NIHSS assessment of the sensitiv- ity and specificity were 87% and 92 %, the specificity and sensitivity was higher than using CTA or NIHSS assess- ment, the difference was not statistically significant （ P 〉0.05）.[Conclusion]more asymmetric in ICV could be used as a predictive poor rehabilitation indicators, and the CTA images combined with NIHSS score was further improve the prediction accuracy of the rehabilitation of patients.