磁敏感血管征对预测急性缺血性脑卒中静脉溶栓后血管再通的价值

Study of susceptibility vessel sign in predicting recanalization after rt-PA thrombolysis in acute ischemic stroke

目的:探讨大脑中动脉(MCA)的磁敏感血管征(SVS)对预测急性缺血性脑卒中患者静脉溶栓后血管再通的意义。方法:纳入70例发病6h内急性前循环脑梗死患者,均接受MRI检查并记录患者年龄、性别、起病到首次MRI扫描时间、高血压史、糖尿病史、房颤史、吸烟史、溶栓前NIHSS评分、溶栓前后血管再通分级评分及90d后mRS评分。根据SVS将70例患者分为SVS阳性组和SVS阴性组。计量资料的组间比较采用Mann-Whitney U检验;分类资料的组间比较采用χ2检验;缺血性脑卒中危险因素及SVS存在情况与溶栓后血管再通情况的相关性采用二分类logistic回归分析。结果:SVS阳性组44例,SVS阴性组26例。两组之间年龄、性别、起病到首次MRI扫描时间、高血压史、糖尿病史、房颤史、吸烟史、溶栓前NIHSS评分、病因分型差异均无统计学意义(P>0.05)。SVS阳性组的溶栓后血管再通比例显著高于SVS阴性组(χ2=16.41,P<0.001)。结论:MCA的SVS有助于预测rt-PA静脉溶栓后的急性缺血性脑卒中患者的血管再通情况。

Objective：To investigate the value of susceptibility vessel sign（SVS）showing on middle cerebral artery（MCA）in the prediction of vessel recanalization after rt-PA thrombolysis.Methods：Seventy patients with acute ischemic stroke with the onset within 6hours were recruited.All had routine MR study,clinical materials including age,sex,time from onset of symptoms to the first MR study,history of hypertension,diabetes mellitus,atrial fibrillation,smoking,NIHSS score before thrombolysis,TICI score before and after thrombolysis,mRS score 90 dafter treatment were acquired.Patients were divided to SVS positive and SVS negative groups.Significance of intergroup differences were assessed using Chi-square test for categorical variables and the Mann-Whitney U test for continuous variables.Binary logistic regression analysis was performed for the estimation of correlation between risk factors of ischemic stroke and vessel recanalization,SVS and vessel recanalization.Results：Of the 70 patients,there were SVS positive（44patients）and SVS negative（26patients）.No significant difference was existed between the two groups in age,sex,time from onset of symptoms to the first MR study,history of hypertension,diabetes mellitus,atrial fibrillation,smoking,NIHSS score before thrombolysis and differenct causes of disease（P〉0.05）.Vessel recanalization in SVS positive group was markedly higher than that of SVS negative group,with significant statistical difference（χ2=16.41,P〈0.001）.Conclusion：SVS of MCA is a useful predictor for early recannalization after rt-PA in acute ischemic stroke.