脑中动脉中度狭窄以上患者病灶侧侧支循环开放与灌注参数及出院3个月mRS评分相关性分析

Correlation analysis on open side collateral circulation and perfusion parameters and mRS scores in 3 months after discharge of patients with moderate stenosis in middle cerebral artery

目的探讨脑中动脉中度狭窄以上患者病灶侧侧支循环开放与灌注参数及出院3个月mRS评分的相关性。方法前瞻性选取2013年12月至2015年12月在邯郸市中心医院就诊的急性脑梗死(ACI)患者115例,进行CT灌注成像(CTP)和CT血管成像(CTA)检测,依据患者血管狭窄程度分成轻度(42例)、中度(39例)和重度(34例)组,依据血管狭窄中度、重度患者侧支循环评分(CS)分为侧支循环良好组(37例)和不良组(36例);对比轻度、中度和重度患者健康侧和病灶侧灌注参数情况;对比侧支循环不良组和良好组患者年龄、同型半胱氨酸(HCY)、总胆固醇(TC)、高血压、低密度脂蛋白(LDL-C)、灌注参数、入院NIHSS数值及出院3个月的mRS评分差异情况。结果轻度狭窄患者病灶侧CBF、CBV较健康侧显著下降,差异具有统计学意义(P<0.05);中度狭窄患者病灶侧CBV低于健康侧,MTT及TTP高于健康侧,差异均具有统计学意义(P<0.05);重度狭窄患者病灶侧CBV及CBF均低于健康侧,差异均具有统计学意义(P<0.05)。对中度和重度患者进行CS评分显示,侧支循环不良组与良好组患者在出院3个月时mRS评分、CBV、MTT、TTP、CBF及入院时的NIHSS评分方面比较,差异均具有统计学意义(P<0.05)。结论脑中动脉中度狭窄以上患者对其脑血流灌注影响严重,不利于患者预后改善。

Objective To exploree the relationship between perfusion parameters and mRS scores in 3 months after the discharge of patients with moderate stenosis in middle cerebral artery. Methods 115 patients with ACI treated in this hospital during December 2013 to December 2015 were prospectively selected for CT perfusion imaging（ CTP） and CT angiography（ CTA）. According to the degree of vascular stenosis,all these patients were divided into mild group（ 42 cases）,moderate group（ 39 cases） and severe group（ 34 cases）. The collateral circulation scores（ CS） were divided into good collateral circulation group（ 37 cases） and poor collateral circulation group（ 36 cases） according to moderate and severe vascular stenosis. The parameters of healthy side and lesion side were compared with levels of HCY,total cholesterol（ TC）,high blood pressure,level of low density lipoprotein（ LDL-C）,perfusion parameters,hospital NIHSS scores,and duration of hospital stay were compared,and the differnce between patients with poor and good collateral circulation in 3 months witth mRS scores. Results A total of 42 patients with mild stenosis,the ipsilateral CBF and CBV compared with those of healthy side were significantly decreased,and the difference was statistically significant（ P〈0. 05）. The ipsilateral CBV in 39 patients with moderate stenosis was lower than that of healthy side,and MTT and TTP were lower than those of healthy side,and the difference was statistically significant（ P〈0. 05）. Patients with severe stenosis were 34 cases,the ipsilateral CBV and CBF were lower than those of healthy side with low contrast,and the difference was statistically significant（ P〈0. 05）. In patients with moderate and severe CS scores showed that poor collateral circulation groups had 36 cases and 37 cases. Patients in these 2 groups compared in 3 months after discharge,the difference among mRS scores,CBV,MTT,TTP,CBF and NIHSS scores at admission were statistically significant（ P〈0. 05）. Conclusion Patients with moderate stenosis in cerebral artery are more seriously impact on cerebral perfusion,thus they are not beneficial to the improvement in prognosis of these patients.