弥散加权成像-阿尔伯塔卒中项目早期CT评分对急性前循环脑梗死早期神经功能恶化的预测价值

Value of DWI-ASPECTS to the prediction of early neurological deterioration in patients with acute anterior circulation cerebral infarction

目的探讨弥散加权成像-阿尔伯塔卒中项目早期CT评分(diffusion-weighted imaging-Alberta stroke program early CT scale,DWI-ASPECTS)预测急性前循环脑梗死患者发生早期神经功能恶化(early neurological deterioration,END)的价值。方法328例急性前循环脑梗死患者,住院期间发生END者76例为END组,未发生END者252例为非END组。记录2组性别、年龄、合并基础疾病、急性卒中治疗低分子肝素试验(the Trial of Org 10172 in acute stroke treatment,TOAST)分型、发病至入院时间;比较2组入院时美国国立卫生研究院卒中量表评分(National Institutes of Health Stroke Scale score,NIHSS),DWI-ASPECTS评分,白细胞计数,血尿酸,血清高敏C反应蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、同型半胱氨酸水平及血栓弹力图R时间、K时间;多因素logistic回归分析急性前循环脑梗死患者发生END的影响因素;绘制ROC曲线,评估入院时NIHSS评分、DWI-ASPECTS评分及R时间预测急性前循环脑梗死患者发生END的价值。结果END组合并冠心病比率(18.42%)、入院时NIHSS评分[(5.18±1.76)分]及血清高敏C反应蛋白[(3.84±0.76)mg/L]、总胆固醇[(4.13±1.02)mmol/L]、低密度脂蛋白胆固醇[(2.65±0.62)mmol/L]水平均高于非END组[9.13%、(4.23±1.18)分、(3.49±0.68)mg/L、(3.89±0.87)mmol/L、(2.49±0.56)mmol/L](P<0.05),入院时DWI-ASPECTS评分[(5.36±1.32)分]低于非END组[(6.53±1.40)分](P<0.05),R时间[(3.76±0.92)min]、K时间[(1.39±0.43)min]均短于非END组[(4.39±1.15)、(1.65±0.49)min](P<0.05),男性、年龄>65岁及合并高血压、糖尿病、高脂血症、脑卒中比率,TOAST分型,发病至入院时间,白细胞计数,血尿酸及血清三酰甘油、高密度脂蛋白胆固醇、同型半胱氨酸水平与非END组比较差异均无统计学意义(P>0.05)。入院时NIHSS评分(OR=1.331,95%CI:1.154~1.792,P=0.015)、DWI-ASPECTS评分(OR=0.516,95%CI:0.389~0.671,P=0.006)及R时间(OR=0.721,95%CI:0.452~0.838,P=0.024)是急性前循环脑梗死患者发生END的影响因素。入院时NIHSS评分、DWI-ASPECTS评分及R时间分别以5分、7分、3.95 min为最佳截断值,预测急性前循环脑梗死患者发生END的AUC分别为0.763(95%CI:0.695~0.832,P<0.001)、0.861(95%CI:0.803~0.918,P<0.001)、0.733(95%CI:0.672~0.793,P<0.001),灵敏度分别为73.68%、79.85%、76.32%,特异度分别为65.08%、80.16%、61.90%;入院时DWI-ASPECTS评分预测急性前循环脑梗死患者发生END的AUC大于入院时NIHSS评分、R时间(Z=3.892,P<0.001;Z=5.314,P<0.001)。结论DWI-ASPECTS评分是急性前循环脑梗死患者发生END的影响因素,其预测END发生有较高价值。

Objective To investigate the value of diffusion-weighted imaging-Alberta stroke program early CT scale(DWI-ASPECTS)to the prediction of early neurological deterioration(END)in patients with acute anterior circulation cerebral infarction.Methods Totally 328 patients with acute anterior circulation cerebral infarction were divided into END group(n=76)and non-END group(n=252)according to the occurrence of END after admission.The gender,age,underlying diseases,the Trial of Org 10172 in acute stroke treatment(TOAST)classification,time from onset to admission,National Institutes of Health Stroke Scale(NIHSS)score,DWI-ASPECTS score,white blood cell count,serum uric acid,serum high-sensitivity C-reactive protein,total cholesterol,triacylglycerol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,homocysteine,and thromboelastography R time and K time were collected and compared between two groups.Multivariate logistic regression was done to analyze the influencing factors of END in patients with acute anterior circulation cerebral infarction.ROC curve was drawn to evaluate the values of NIHSS score,DWI-ASPECTS score and R time on admission to the prediction of END in patients with acute anterior circulation cerebral infarction.Results The percentage of patients with coronary heart disease(18.42%),NIHSS score on admission(5.18±1.76),serum high-sensitivity C-reactive protein[(3.84±0.76)mg/L],total cholesterol[(4.13±1.02)mmol/L]and low-density lipoprotein cholesterol[(2.65±0.62)mmol/L]in END group were higher than those in non-END group[9.13%,4.23±1.18,(3.49±0.68)mg/L,(3.89±0.87)mmol/L,(2.49±0.56)mmol/L](P<0.05),DWI-ASPECTS score on admission was lower in END group(5.36±1.32)than that in non-END group(6.53±1.40)(P<0.05),R time and K time were shorter in END group[(3.76±0.92),(1.39±0.43)min]than those in non-END group[(4.39±1.15),(1.65±0.49)min](P<0.05),and there were no significant differences in the percentages of male patients,patients aged over 65years,patients with hypertension,diabetes,hyperlipidemia and stroke,TOAST classification,time from onset to admission,white blood cell count,serum uric acid,serum triacylglycerol,high-density lipoprotein cholesterol and homocysteine levels between two groups(P>0.05).NIHSS score on admission(OR=1.331,95%CI:1.154-1.792,P=0.015),DWI-ASPECTS score(OR=0.516,95%CI:0.389-0.671,P=0.006),and R time(OR=0.721,95%CI:0.452-0.838,P=0.024)were the influencing factors of END in patients with acute anterior circulation cerebral infarction.When the optimal cut-off values of NIHSS score,DWI-ASPECTS score and R time on admission were 5,7and 3.95min,the AUCs for predicting END in patients with acute anterior circulation cerebral infarction were 0.763(95%CI:0.695-0.832,P<0.001),0.861(95%CI:0.803-0.918,P<0.001)and 0.733(95%CI:0.672-0.793,P<0.001),the sensitivities were 73.68%,79.85%and76.32%,and the specificities were 65.08%,80.16%and 61.90%,respectively.The AUCof DWI-ASPECTS score for predicting END was higher than that of NIHSS score and R time on admission(Z=3.892,P<0.001;Z=5.314,P<0.001).Conclusion DWI-ASPECTS score is an independent influencing factor of END in patients with acute anterior circulation cerebral infarction,and it has a high predicting value.