大脑中动脉高密度征长度对急性脑梗死静脉溶栓再通率及疗效的预测价值

Predictive value of length of hyperdense middle cerebral artery sign on recanalization rate and curative effect of intravenous thrombolysis in acute cerebral infarction

目的探讨大脑中动脉高密度征(HMCAS)对急性脑梗死接受阿替普酶溶栓后再通率及疗效、安全性。方法回顾性分析2017年1月至2021年3月在南通市第二人民医院神经内科住院且伴有HMCAS接受阿替普酶静脉溶栓治疗的脑梗死患者资料,根据大脑HMCAS长度分为短大脑中动脉高密度(SHMCAS)组(长度<1 mm)30例和长大脑中动脉高密度(LHMCAS)组(长度≥1 mm)32例。发病后24 h,采用头颅TOF-MRA评判两组间大脑中动脉再通情况;采用美国国立卫生研究院卒中量表(NIHSS)评分评判两组治疗后24、72 h预后情况;采用改良Rankin量表(mRS)评判两组治疗后3个月的预后情况;分析住院期间两组的安全性情况。结果SHMCAS组再通率较LHMCAS组高,差异有统计学意义(P<0.05);SHMCAS组治疗后24、72 h NIHSSS评分比较差异无统计学意义(P>0.05);SHMCAS组治疗后3个月预后良好的比例高于LHMCAS组,差异有统计学意义(P<0.05);SHMCAS组梗死后出血转化率低于LHMCAS组(P<0.05),但两组症状性颅内出血率差异无统计学意义(P>0.05)。结论HMCAS长度能预测脑梗死阿替普酶静脉溶栓后再通率、治疗后3个月mRS评分及梗死后出血转化率。

Objective To investigate the effect of hyperdense middle cerebral artery sign(HMCAS)on the recanalization rate,efficacy and safety of alteplase thrombolysis in the patients with acute cerebral infarction.Methods The data of the patients with cerebral infarction and HMCAS receiving alteplase venous thrombolysis treatment hospitalized in the internal medicine department of this hospital from January 2017 to March 2021 were retrospectively analyzed.The patients were divided into the short middle cerebral artery high density(SHMCAS)group(length<1 mm,n=30)and long middle cerebral artery high density(LHMCAS)group(length≥1 mm,n=32)according to the length of HMCAS.The recanalization of middle cerebral artery was evaluated by 24 h TOF-MRA;the National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the prognosis at 24 h and 72 h;the modified Rankin scale(mRS)was used to evaluate the prognosis in 3 months;the safety of the two groups during hospitalization was analyzed.Results The recanalization rate in the SHMCAS group was higher than that in the LHMCAS group,and the difference was statistically significant(P<0.05);there was no statistically significant difference in the NIHSSS scores in the SHMCAS group between at 24 h and 72 h(P>0.05).The good prognosis rate at 3 months in the SHMCAS group was higher than that in the LHMCAS group and the difference was statistically significant(P<0.05);the postinfarction hemorrhagic transformation rate in the SHCAS group was lower than that in the LHMCAS group(P<0.05),but there was no statistically significant difference in the rate of symptomatic intracranial hemorrhage between the two groups(P>0.05).Conclusion The length of HMCAS could predict the recanalization rate,mRS score at 3 months and postinfarction hemorrhage conversion rate after alteplase intravenous thrombolysis.