3D-ASL对急性缺血性脑卒中患者严重程度及预后的评估价值分析

Evaluation value of 3D-ASL in severity and prognosis of patients with acute ischemic stroke

目的探讨磁共振三维动脉自旋标记技术(three-dimensional arterial spin labeling,3D-ASL)预测急性缺血性脑卒中(acute ischemic stroke,AIS)患者严重程度及预后的临床应用价值。方法根据美国国立卫生研究院卒中量表评分(National Institutes of Health Stroke Scale,NIHSS),将128例AIS患者分为轻度组、中度组、重度组,所有患者入院当天均行3D-ASL扫描检查,获取梗死区域脑血流量(cerebral blood flow,CBF)值,酶联免疫吸附法检测血清Apelin-13蛋白水平。入院两周后改良Rankin量表(modified Rankin Scale,mRS)评价患者神经功能恢复状况,改良Barthel指数(modified Barthel index,MBI)评定量表评价患者日常生活能力。分析入院当天患者脑梗死区域CBF值与NIHSS评分、Apelin-13蛋白水平、mRS评分、MBI指数的相关性。绘制ROC曲线,确定预测AIS患者严重程度的CBF截断值。结果入院当天,中度组、重度组患者的NIHSS评分明显高于轻度组,脑梗死区CBF值、血清Apelin-13蛋白水平明显低于轻度组;重度组患者的NIHSS评分又明显高于中度组,脑梗死区CBF值、血清Apelin-13蛋白水平明显低于中度组。患者入院当天脑梗死区的CBF值与NIHSS评分呈负相关关系,与血清Apelin-13蛋白水平呈正相关关系;入院两周后,中度组、重度组患者的MBI指数明显低于轻度组,mRS评分则高于轻度组,重度组患者的MBI指数又明显低于中度组,mRS评分则高于中度组。入院当天的脑梗死区CBF值与两周后的MBI指数呈正相关关系,与mRS评分呈负相关关系。轻度组与中度组的脑梗死灶CBF截断值为20.5 mL·min^(-1)·100 g^(-1),ROC曲线下面积为0.946,中度组与重度组的CBF截断值为13.5 mL·min^(-1)·100 g^(-1),ROC曲线下面积为0.924。结论入院当天行无创3D-ASL技术可预测AIS患者严重程度及预后,对治疗方法的应用和调整具有指导意义。

Objective To explore the clinical value of magnetic resonance three-dimensional arterial spin labeling(3D-ASL)in predicting the severity and prognosis of patients with acute ischemic stroke(AIS).Methods According to the National Institutes of Health Stroke Scale(NIHSS)score,128 AIS patients diagnosed in our hospital were divided into mild group,moderate group and severe group.All the subjects underwent the 3D-ASL scan examination on the day of admission to obtain the cerebral blood flow(CBF)in infarcted area.The protein level of Apelin-13 in serum was detected by enzyme-linked immunosorbent assay.At two weeks after admission,the neurological function recovery of patients was evaluated with modified Rankin Scale(mRS),and the activity of daily life(ADL)was evaluated with the modified Barthel Index(MBI).The correlation between CBF in cerebral infarction area on the day of admission and NIHSS score,Apelin-13 protein level,mRS score,MBI index was analyzed.Receiver operating characteristic(ROC)curve was drawn to determine the CBF cut-off value for predicting the severity of AIS.Results On the day of admission,the NIHSS score of moderate group and severe group was significantly higher than that of mild group,while the CBF value in cerebral infarction area and Apelin-13 protein level in serum were significantly lower than those in mild group.The NIHSS score of severe group was significantly higher than that of moderate group,while the CBF value in cerebral infarction area and Apelin-13 protein level in serum were significantly lower than those in moderate group.The CBF value in cerebral infarction area was negatively correlated with NIHSS score,and positively correlated with Apelin-13 protein level in serum.At two weeks after admission,the MBI index of moderate group and severe group was significantly lower than that of mild group,while mRS score was higher than that of mild group.The MBI index of severe group were significantly lower than that of moderate group,while mRS score was higher than that of moderate group.The CBF value in cerebral infarction area was positively correlated with MBI index,and negatively correlated with mRS score on the day of admission.The CBF cut-off value in mild group and moderate group was 20.5 mL·min^(-1)·100 g^(-1),and the area under ROC curve was 0.946.The CBF cut-off value in moderate group and severe group was 13.5 mL·min^(-1)·100 g^(-1),and the area under ROC curve was 0.924.Conclusion Noninvasive 3D-ASL on the day of admission can be used to predict the severity and prognosis of AIS patients,which has guiding significance for the application and adjustment of treatment methods.