亚急性期基底节区脑出血的CT灌注表面通透性探讨

Study on CT perfusion surface permeability of cerebral hemorrhage in the basal ganglia region in subacute stage

目的利用CT灌注成像（CTPI）探讨亚急性期基底节区脑出血局部的灌注表面通透性（Ps）变化及其与影响因素的相关性。方法对2015年11月至2016年6月在温州医科大学附属第一医院神经内科住院的亚急性期内（4d～2周）35例脑出血患者行CTPI检查，分别测量血肿边缘区、血肿近侧和血肿远侧的Ps、脑血流量、脑血容量、平均通过时间（MTT），计算各灌注参数的相对值（患侧／健侧）。分析血肿边缘Ps值与发病时间、血肿、水肿体积的相关性，同时分析入院、CTPI检查时以及出院时的NIHSS评分与血肿边缘PS的相关性。结果35例亚急性期内脑出血患者血肿边缘PS为（1．87±0．48）ml·100g^-1·min^-1，边缘镜像侧PS为（1．28±0．34）ml·100g^-1·min^-1，差异有统计学意义（t=-12．407，P〈0．01）；血肿近侧PS相对值（rPS）为1．81±0．50，血肿远侧rPS为1．04±0．21，差异有统计学意义（t=7．936，P〈0．001）。血肿边缘Ps与发病时间（5-12d）呈直线正相关（r=0．507，P〈0．05），但与血肿体积、水肿体积无显著相关性（均P〉0．05）。20例患者血肿体积小于10ml，血肿边缘Ps为（1．83±0．32）ml·100g^-1·min^-1；15例患者血肿体积大于10ml，血肿边缘Ps为（1．92±0．47）ml·100g^-1·min^-1；两者差异无统计学意义（P〉0．05）。患者人院时、CTPI检查时以及出院时的NIHSS评分与血肿边缘Ps均无显著相关（均P〉0．05）。结论在脑出血亚急性期，血肿周围组织的血脑屏障功能持续异常，表现为通透性增高。血肿边缘PS与患者发病时间呈正相关。CTPI的PS参数可准确反映血脑屏障通透性改变，为脑出血的评估和个体化治疗提供有价值的信息。

Objective To investigate alterations of permeability of surface （PS） in subacute stage patients with intracerebral hemorrhage （ICH） using computed tomography perfusion imaging （CTPI）, and analyze relationships between PS and other factors. Methods CTPI was performed in 35 patients in subacute stage （4 days -2 weeks） after onset of ICH, who were recruited in the Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University from November 2015 to June 2016. Hematoma and edema volumes were measured, and perfusion parameters of perihematoma and mirror hemisphere side of marginal zone and outer zone of hematoma, including cerebral blood flow （ CBF ） , cerebral blood volume （CBV）, mean transit time （MTF）, PS, and relative value （ipsilateral/eontralateral） of CBF （rCBF） , CBV （rCBV） , MT1~ （rMTI＇） and PS （rPS） , were calculated. Relationships between volumes of hematoma and edema, time from onset to CTPI performance, NIHSS scores and PS of perihematoma zone were analyzed by Pearson correlation analysis. Results The perihematoma PS （ （ 1.87 ± 0. 48 ） ml · 100 g^-1 . min^-1 ） was higher than that incontralateral regions （（1.28±0.34） ml ± 100 g^-l . min^-l; t = -12.407, P〈 O. 01）. Meanwhile, there was a statistically significant difference between rPS in proximal area （1.81 ±0. 50） and rPS in outer area （ 1.04±0. 21 ） （t =7. 936, P 〈0. 001 ）. The absolute value of perihematoma PS had a positive correlation with the time from onset to CTPI performance （ r = 0. 507, P 〈 0. 05 ）. But there were no statistically significant correlations between perihematoma PS and volumes of hematoma or edema （both P 〉 0. 05 ）. There were 20 patients with hematoma volume less than 10 ml and 15 patients with hematoma volume more than 10 ml, while the mean value of perihematoma PS of them showed no statistically significant difference （P 〉 0. 05 ）. And there were no statistically significant correlations between perihematoma PS and NIHSS scores at the time of admission, CTPI examination and discharge （ all P 〉 0. 05 ）. Conclusions In subacutc stage of ICH, the blood brain barrier permeability of perihematoma area is still abnormal, manifested as PS increases. The perihematoma PS positively correlates with the time of ICH onset. CTPI can accurately reflect this change, and potentially provide valuable information for evaluation and individual treatment of patients.