大脑中动脉型脑卒中深部髓质静脉与临床预后相关性分析

Analysis of the correlation between deep medullary veins and clinical prognosis of middle cerebral artery stroke

摘要 目的应用磁敏感加权成像研究大脑中动脉型脑卒中深部髓质静脉分布与临床预后相关性。 方法回顾分析2015年1—10月沈阳军区总医院144例大脑中动脉型脑卒中患者和55名健康志愿者脑深部髓质静脉（DMV）对称性及分型，其中共随诊30例。采用一致性检验（kappa）判定两位医师诊断DMV对称性及分型数据的一致性。 结果DMV对称性和分型的一致性kappa值分别为0.875和0.852。对照组和脑卒中组DMV对称性χ2检验差异有统计学意义（χ2＝31.046，P＝0.000）。脑卒中组DMV分型与临床美国国立卫生研究院脑卒中量表（NIHSS）评分相关（rs＝0.208，P＝0.025）。各期脑卒中组DMV分型总体分布差异无统计学意义（P＝0.110）。急性脑卒中与慢性期脑卒中DMV分型总体分布差异有统计学意义（P＝0.018）。30例DMV随诊中，18例治疗前不对称的DMV分布转变为对称分布；8例对称分布的DMV管径变细，4例DMV未见变化。 结论大脑中动脉型脑卒中患者DMV多为不对称分布。DMV分型可以作为一种影像学指标来预测脑卒中预后。

ObjectiveTo investigate the relativity between the distribution of deep medullary vein （DMV） in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging （SWI）. MethodsA total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists. ResultsKappa value in DMV symmetry and DMV type were 0.875 and 0.852. Chi-square test analysis revealed a statistically significant difference of DMV symmetry between healthy control and stroke group（χ2=31.046, P=0.000）. There was correlation between DMV type and NIHSS score in stroke group （rs=0.208, P=0.025）. There was no statistically significant difference of DMV distribution in the different periods of stroke group （P=0.110）. But there was statistically significant difference of DMV distribution between acute and chronic stroke （P=0.018）. Among 30 follow-up cases, 18 cases with asymmetry DMV changed into symmetry after stroke therapy. In 8 cases with symmetry DMV, the diameter of DMV became smaller after treatment. In 4 cases, DMV had no changes. ConclusionsDMV in patients of MCA stroke are mostly asymmetry distribution. DMV classification can be used as an imaging standard to predict the prognosis of stroke patients.