大脑中动脉重度狭窄及闭塞患者侧支循环及脑灌注评估与预后的关系

The relationship of collateral circulation and cerebral perfusion evaluation with prognosis for patients with severe stenosis in middle cerebral artery

目的探讨大脑中动脉重度狭窄及闭塞的急性脑梗死患者责任血管范围侧支循环及磁共振灌注状态与预后的关系。方法选取2018年1月-2019年7月在徐州医科大学附属医院神经内科住院行CT血管成像检查诊断单侧大脑中动脉重度狭窄及闭塞的急性脑梗死患者79例,根据侧支循环情况分为侧支循环良好组及侧支循环不良组,均行磁共振灌注加权成像检查,比较灌注参数情况、入院时与治疗7 d后NIHSS评分及出院3个月后的MRS评分、出院3个月内终点事件情况。结果 (1)侧支循环良好组患侧rCBV增加,rTTP、rMTT延长(P均<0.01);侧支循环不良组患侧rTTP、rMTT延长,患侧rCBF降低(P<0.01);(2)侧支循环不良组患侧rMTT、rCBV低于侧支循环良好组(P<0.05);(3)侧支循环良好组入院时、治疗7 d后NIHSS评分、出院3个月后MRS评分、出院3个月内终点事件发生率均较侧支循环不良组低(P<0.05)。结论良好的侧支循环及脑灌注状态对大脑中动脉重度狭窄及闭塞导致急性脑梗死患者的预后改善有重要意义。

Objective To study the relationship between collateral circulation in the range of blood vessel,magnetic resonance perfusion state and prognosis in acute cerebral infarction patients with severe stenosis and occlusion in middle cerebral artery.Methods 79 acute ischemic stroke patients with severe stenosis and occlusion in middle cerebral artery at affiliated hospital of Xuzhou Medicine University from February 2018 to July 2019 were selected prospectively. And they were hospitalized and conducted CT blood vessel imaging inspection in Neurology Department. According to collateral circulation, they were divided into the good collateral circulation group and bad collateral circulation group. All of them conducted magnetic resonance perfusion weighing imaging inspection. The perfusion parameter situations, NIHSS at admission and after 7 d of treatment, MRS after discharging for 3 months and end situation were compared.Results Comparison of cerebral perfusion parameters at the uninjured side and affected side of patients in different collateral circulation groups showed that the good collateral circulation group increased rCBV and lengthened rTTP and rMTT(P<0.01). The bad collateral circulation group lengthened rTTP and rMTT and decreased rCBF in the affected side(P<0.01). rMTT and rCBV at the affected side in the bad collateral circulation group were lower than those in the good collateral circulation group(P<0.05). Before and after treatment, NIHSS, MRS after 3 months, and end occurrence in the good collateral circulation group were lower than those in the bad collateral circulation group(P<0.05).Conclusion In patients with acute cerebral infarction caused by severe stenosis and occlusion of middle cerebral artery, good collateral circulation and cerebral perfusion were beneficial to the improvement of prognosis.