MRI DTI参数联合血清ACA、aβ2-GP1在脑梗死诊断中的应用价值

Application value of MRI DTI parameters combined with serum ACA and aβ2-GP1 in the diagnosis of cerebral infarction

目的探讨磁共振成像(MRI)弥散张量成像(DTI)参数联合血清抗心磷脂抗体(ACA)、抗β2糖蛋白1抗体(aβ2-GP1)在脑梗死诊断中的应用价值。方法回顾性选取2015年6月至2017年1月在承德医学院附属医院接受治疗的脑梗死患者131例作为观察组,同时选取同期在神经内科接受治疗的非脑梗死患者50例作为对照组。观察组根据病灶大小分为小面积梗死组58例,中面积梗死组41例,大面积梗死组32例;根据严重程度分为轻度组67例,中重度组64例;根据预后效果分为预后良好组90例,预后不良组41例。比较两组血清ACA、aβ2-GP1差异,同时比较不同梗死面积、严重程度及预后患者血清ACA、aβ2-GP1以及各向异性分数(FA)值、表观扩散系数(ADC)值差异。结果观察组血清ACA、ab2-GP1分别为(8.95±1.87)、(14.87±3.35)RU/mL,明显高于对照组,差异均有统计学意义(P<0.05)。随着梗死面积增加,患者病灶FA值和ADC值降低,而血清ACA、aβ2-GP1升高,差异均有统计学意义(P<0.05)。观察组中重度患者FA值和ADC值分别为0.38±0.10和(2.88±0.91)×10^(-3)mm^(2)/s,均明显低于轻度患者,而ACA和aβ2-GP1分别为(9.82±1.32)、(16.46±3.08)RU/mL,均明显高于轻度患者,差异均有统计学意义(P<0.05)。观察组预后不良患者FA值和ADC值分别为0.36±0.12和(2.62±0.94)×10^(-3)mm^(2)/s,均明显低于预后良好患者,而ACA和aβ2-GP1分别为(10.55±1.15)、(17.26±3.12)RU/mL,明显高于预后良好患者,差异均有统计学意义(P<0.05)。FA值、ADC值联合血清ACA、aβ2-GP1预测患者预后不良的ROC曲线面积为0.911,明显高于各参数单独预测的0.715、0.768、0.793和0.820,P<0.05。结论MRI DTI参数FA值、ADC值以及血清ACA、aβ2-GP1与脑梗死梗死面积、严重程度及预后有关,且在联合预测患者预后方面有一定应用价值。

Objective To investigate the value of magnetic resonance imaging(MRI)diffusion tensor imaging(DTI)parameters combined with serum anticardiolipin antibody(ACA)and anti-β2 glycoprotein 1 antibody(aβ2-GP1)in the diagnosis of cerebral infarction.Methods A total of 131 patients with cerebral infarction treated in Affiliated Hospital of Chengde Medical College from June 2015 to January 2017 were retrospectively seleted as the observation group and 50 patients with non cerebral infarction treated in Department of Neurology in the same period were selected as the control group.According to the size of the lesions,the patients in observation group were divided into small infarction group(58 cases),medium infarction group(41 cases)and large infarction group(32 cases);according to the severity,they were divided into mild group with 67 cases and moderate-severe group with 64 cases;according to the prognostic effect,90 cases were divided into a good prognosis group and 41 cases in a poor prognosis group.The differences of serum ACA and aβ2-GP1 between the two groups were compared,and the values of serum ACA,aβ2-GP1 and fractional anisotropy(FA)and apparent diffusion coefficient(ADC)in patients with different infarct size,severity and prognosis were compared.Results Serum ACA and aβ2-GP1 in the observation group were(8.95±1.87),(14.87±3.35)RU/mL respectively,which were significantly higher than those in the control group,the differences were statistically significant(P<0.05).With the increase of infarct size,FA and ADC decreased,while serum ACA and aβ2-GP1 increased,the differences were statistically significant(P<0.05).The FA and ADC values of moderate and severe patients in the observation group were 0.38±0.10 and(2.88±0.91)×10^(-3)mm^(2)/s,which was significantly lower than that in mild patients,while ACA and aβ2-GP1 were(9.82±1.32),(16.46±3.08)RU/mL,which was significantly higher than that in mild patients,the differences were statistically significant(P<0.05).The FA and ADC values of patients with poor prognosis in the observation group were 0.36±0.12 and(2.62±0.94)×10^(-3)mm^(2)/s,which were significantly lower than those in patients with good prognosis,while ACA and aβ2-GP1 were(10.55±1.15),(17.26±3.12)RU/mL,which were significantly higher than those in patients with good prognosis,and the differences were statistically significant(P<0.05).The ROC curve area of FA value and ADC value combined with serum ACA and aβ2-GP1 in predicting poor prognosis was 0.911,which was significantly higher than predicted by each parameter alone 0.715,0.768,0.793 and 0.820.Conclusion MRI DTI parameters FA value,ADC value,serum ACA and aβ2-GP1 are related to the infarct size,severity and prognosis of cerebral infarction,and have certain application value in jointly predicting the prognosis of patients.