侧支循环对于FLAIR高信号血管征评估急性脑梗死预后的影响

Influence of collateral circulation on prognostic evaluation of hyperintense vessel sign of FLAIR in acutecerebral infarction

目的:本研究以软脑膜侧支循环开放程度进行分层,探讨不同侧支循环亚组中FLAIR血管高信号征(HVS)的预后评估价值。方法:搜集前循环大血管闭塞(LVO)急性脑梗死患者149例,以区域性软脑膜侧支(rLMC)评分分为rLMC≤10组(n=82)和rLMC>10组(n=67)。应用散点图分析HVS评分与rLMC的相关性、Logistic回归模型探讨HVS与预后的关系。结果:全组患者中,HVS评分与rLMC评分呈凸形曲线相关(R^(2)=0.416);rLMC评分是患者预后良好(mRS<2)的独立预测因子(P_(2)<0.001,OR_(2)=0.708),而HVS评分与患者预后无明显相关性(P_(1)=0.263,OR_(1)=1.111)。rLMC≤10组中,HVS评分与rLMC评分呈曲线正相关(R_(2)=0.352);HVS评分、rLMC评分均与患者预后良好呈正相关(P_(1)=0.004,OR_(1)=0.453;P_(1)=0.022,OR_(1)=0.692),HVS评分是患者预后良好的独立预测因子(P_(2)=0.048,OR_(2)=0.490)。rLMC>10组中,HVS评分与rLMC评分呈曲线负相关(R_(2)=0.472);HVS评分与患者预后良好呈负相关(P_(1)=0.005,OR_(1)=3.627),rLMC评分与患者预后良好呈正相关(P_(1)=0.001,OR_(1)=0.342),rLMC评分是患者预后良好的独立预测因子(P_(2)=0.015,OR_(2)=0.396)。结论:前循环LVO急性脑梗死HVS评分与侧支循环评分呈凸形曲线关系。采用HVS评分预测前循环LVO急性脑梗死预后时,侧支循环开放情况是必须考虑的因素。

Objective:This study was stratified according to the degree of leptomeningeal collateral circulation opening to explore the prognostic value of hyperintense vessel sign(HVS)of FLAIR in different subgroups of collateral circulation.Methods:A total of 149 patients with acute cerebral infarction with large vessel occlusion(LVO)of anterior circulation were collected and according to the regional leptomeningeal collateral(rLMC)score,divided into rLMC≤10 group(n=82)and rLMC>10 group(n=67).Scatter diagram was used to analyze the correlation between HVS score and rLMC,and Logistic regression analysis was employed to screen the statistically significant prognostic factors.Results:For all patients,HVS showed a convex curve correlation with rLMC(R^(2)=0.416);rLMC score was an independent predictor of favorable outcome(mRS<2)(P_(2)<0.001,OR_(2)=0.708),while HVS score was not significantly related to prognosis(P_(1)=0.263,OR_(1)=1.111).In the rLMC≤10 group,HVS score was positively correlated with rLMC score(R_(2)=0.352);HVS score and rLMC score were both positively related to favorable outcome(P_(1)=0.004,OR_(1)=0.453;P_(1)=0.022,OR_(1)=0.692),and HVS score was an independent predictor of favorable outcome(P_(2)=0.048,OR_(2)=0.490).In the rLMC>10 group,HVS score was negatively correlated with rLMC score(R_(2)=0.472);HVS score was negatively related to favorable outcome(P_(1)=0.005,OR_(1)=3.627),and rLMC score was positively related to favorable outcome(P_(1)=0.001,OR_(1)=0.342);rLMC was an independent predictor of favorable outcome(P_(2)=0.015,OR_(2)=0.396).Conclusion:There was a convex curve correlation between HVS and rLMC in acute cerebral infarction patients with LVO of anterior circulation.When HVS is used to predict the prognosis of acute cerebral infarction with LVO of anterior circulation,the degree of the collateral circulation opening should be taken into consideration.