临床—弥散加权成像不匹配对进展性脑梗死的预测价值研究

Prediction Value of Clinical-diffusion Weighted Imaging Mismatch for Progressive Cerebral Infarction

目的:探讨临床-弥散加权成像不匹配(Clinical-DWI mismatch,CDM)现象对进展性脑梗死的预测价值。方法:收集脑梗死病人80例(非溶栓取栓),入院时和入院后72h两次NIHSS评分增加≥2分者归入进展性脑梗死,其余为非进展性脑梗死组。依据CDM定义:NIHSS评分≥8分且DWI-ASPECTS评分≥8分,将每组病人分为CDM(+)及CDM(-)。应用颈椎MRI+CEMRA或颈动脉B超(不能完成颈椎MRI+CEMRA者)对病人颅内外血管进行检查,通过分析进展性脑梗死组和非进展性脑梗死组病人的CDM、大脑中动脉狭窄、颈内动脉狭窄、入院时NIHSS评分及血液生化指标等,来探讨进展性脑梗死的预测因子,评估CDM对进展性脑梗死的独立预测价值。结果:进展性脑梗死组CDM(+)、大脑中动脉狭窄发生率及入院时NIHSS评分均明显高于非进展组,差异有统计学差异(P<0.05)。进一步Logistic回归分析表明CDM及责任大脑中动脉狭窄可以独立预测进展性脑梗死的发生(P值分别为0.008和0.004)。结论:CDM现象及大脑中动脉狭窄能独立、有效预测进展性脑梗死的发生。

Objective:To investigate the predictive value of clinical-diffusion-weighted imaging mismatch(CDM)phenomenon for progressive cerebral infarction.Methods:A total of 80 patients with cerebral infarction(non-thrombolytic and thrombectomy)who were hospitalized in the Department of Neurology,Yuyao People’s Hospital from June 2018 to June 2019 were collected.The patient completed the NIHSS score immediately upon admission,and again at 72 hours after admission.The two scores increased by 2 or more were classified as progressive cerebral infarction,and the rest were non-progressive cerebral infarction groups.According to the definition of CDM:NIHSS score is 8 or more and DWI-ASPECTS score is 8 or more.Each group of patients is divided into CDM(+)and CDM(-).Use cervical MRI+CEMRA or carotid B-ultrasound(for those who cannot complete cervical MRI+CEMRA)to check the intracranial and extracranial blood vessels of patients,and analyze the CDM,middle cerebral artery stenosis,internal carotid artery stenosis,and blood biochemical indicators in patients with progressive cerebral infarction group and non-progressive cerebral infarction group to explore predictive factors for progressive cerebral infarction and evaluate CDM for progressive brain Independent predictive value of infarction.Results:The incidence of CDM(+)and middle cerebral artery stenosis or occlusion in the progressive cerebral infarction group was significantly higher than that in the non-progressive group,and the differences were statistically significant(P<0.05).Further Logistic regression analysis showed that CDM and responsible middle cerebral artery stenosis or occlusion can independently predict the occurrence of progressive cerebral infarction.Conclusion:CDM phenomenon and middle cerebral artery stenosis or occlusion can independently and effectively predict the occurrence of progressive cerebral infarction.