经颅彩色多普勒超声定量分析急性缺血性卒中患者早期神经功能恶化的风险及预测不良预后的效能

Transcranial color Doppler ultrasound quantitative analysis of the risk of early neurological deterioration in acute ischemic stroke patients and its effectiveness in predicting poor prognosis

目的探讨经颅彩色多普勒超声(TCCD)评估急性缺血性卒中(AIS)患者早期神经功能恶化(END)的风险及预测不良预后的效能。方法选取2018年1月至2020年3月大连医科大学附属第二医院收治的264例AIS患者,根据病情是否进展为END分为END组(55例)、无END组(209例)。应用TCCD检测两组视神经鞘直径(ONSD)/眼球横径(ETD)、大脑中动脉搏动指数(PI)、脑中线移位值ONSD/ETD、PI、脑中线移位值,并对数据进行统计分析。结果END组ONSD/ETD、PI、脑中线移位值高于无END组[0.24±0.02比0.22±0.03、1.26±0.14比1.10±0.12、(4.97±1.13)mm比(3.41±1.05)mm],差异均有统计学意义(P<0.05)。ONSD/ETD、PI、脑中线移位值与美国国立卫生研究院卒中量表(NIHSS)评分呈正相关(r1=0.531、r2=0.599、r3=0.566,P均<0.001)。多因素分析显示,NIHSS评分、血糖、ONSD/ETD、PI、脑中线移位值是AIS患者发生END的危险影响因素(P<0.05)。ONSD/ETD、PI、脑中线移位值联合评估预后AUC为0.896,大于任一单一指标,灵敏度为84.62%,特异度为89.08%。结论TCCD检测ONSD/ETD、PI、脑中线移位值可为临床评估AIS患者END风险提供重要信息。

Objective To investigate the ability of predicting poor prognosis and the diagnosis efficacy of transcranial color Doppler ultrasound(TCCD)in acute ischemic stroke patients.Methods A total of 264 AIS patients admitted to the Second Hospital of Dalian Medical University from January 2018 to March 2020 were selected and divided into early neurological deterioration(END)group(55 patients)and no END group(209 patients).The optic nerve sheath diameter(ONSD)/transverse eyeball diameter(ETD),middle cerebral artery pulsatility index(PI)and midline shift were detected by TCCD,and the results were analyzed.Results The values of ONSD/ETD,PI and midline shift in the END group were higher than those in the no END group:0.24±0.02 vs.0.22±0.03,1.26±0.14 vs.1.10±0.12,(4.97±1.13)mm vs.(3.41±1.05)mm,and the differences were statistically significant(P<0.05).The values of ONSD/ETD,PI,midline shift in the brain were positively correlated with the National Institutes of Health Stroke Scale(NIHSS)scores(r1=0.531,r2=0.599,r3=0.566,all P<0.001).Multivariate analysis showed that NIHSS scores,blood glucose,ONSD/ETD,PI,brain midline shift values were related to END(P<0.05).The prognostic area under the curve of the ONSD/ETD,PI,combined with brain midline shift values in assessing prognosis was 0.896,which was greater than any single index.The sensitivity was 84.62%,and the specificity was 89.08%.Conclusions The detection of ONSD/ETD,PI and midline shift values by TCCD can provide important information for clinical assessment of the risk of END in AIS patients.