DWI-ASPECTS对大脑中动脉供血区急性脑梗死患者早期神经功能恶化的预测价值

The predictive value of DWI-ASPECTS for early neurological deterioration in patients with acute middle cerebral artery territory infarction

目的:探讨扩散加权成像阿尔伯塔卒中项目早期CT评分(DWI-ASPECTS)对大脑中动脉(MCA)供血区急性脑梗死患者发生早期神经功能恶化(END)的预测价值。方法:回顾性分析本院神经内科收治的93例MCA供血区急性脑梗死患者病例资料,根据是否发生END分为非END组和END组,对两组患者的临床和影像数据行差异与回归分析,采用受试者操作特征(ROC)曲线评价DWI-ASPECTS对MCA供血区急性脑梗死患者END的预测价值。结果:93例患者中,发生END者27例(END组),非END组66例。两组比较,END组的DWI-ASPECTS、血管狭窄部位、入院NIHSS评分、入院空腹血糖、糖尿病史与非END组的差异有统计学意义(P<0.05)。二元Logistic回归分析显示,DWI-ASPECTS与END风险相关,差异具有统计学意义(OR=0.736,95%CI:0.564~0.961,P=0.024)。ROC曲线分析显示当DWI-ASPECTS≤4时,DWI-ASPECTS对预测MCA供血区急性脑梗死患者END的敏感度为74.07%,特异度为69.70%,曲线下面积(AUC)为0.745(95%CI:0.644~0.829)。结论:DWI-ASPECTS对大脑中动脉供血区急性脑梗死患者END的发生有一定的预测价值。

Objective:To evaluate the value of diffusion-weighted imaging-Alberta stroke program early computed tomography score(DWI-ASPECTS)for predicting early neurological deterioration(END)in patients with acute middle cerebral artery(MCA)territory infarction.Methods:Ninety-three patients with acute ischemic stroke in the territory of MCA admitted to the department of neurology of our hospital were retrospectively enrolled.These patients were divided into non-END and END groups according to the occurrence of END.The clinical and imaging data were analyzed by the single factor and binary logistic regression analysis.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of DWI-ASPECTS in patients with acute MCA territory infarction.Results:Of the 93 patients,twenty-seven patients developed END(END group),whereas 66 patients without END(non-END group).DWI-ASPECTS,the distribution of stenosis location,the National Institutes of Health Stroke Scale(NIHSS)scores at admission,fasting blood glucose and the history of diabetes were statically significant differences between groups(P<0.05).Binary Logistic regressions indicated that DWI-ASPECTS[odds ratio(OR):0.736;95%confidence interval(CI):0.564~0.961,P=0.024]was significantly correlated with END.ROC curve analysis showed that the sensitivity,specificity,and the area under the curve were 74.07%,69.70%,and 0.745(95%CI:0.644~0.829)in predicting END when DWI-ASPECTS was≤4.Conclusion:DWI-ASPECTS has certain predictive value for the occurrence of END in patients with acute MCA territory infarction.