HRMRI联合血管超声对颈内动脉夹层发生脑梗死预测价值及危险因素评估

Predictive value and risk factors of cerebral infarction in internal carotid artery dissection by hrmri combined with vascular ultrasound

目的:研究颈内动脉夹层(internal carotid dissection,ICD)发生脑梗死的影响因素,以及高分辨率磁共振成像(HRMRI)联合颈部血管超声(CVUS)对颈内动脉夹层发生脑梗死预测价值。方法:选取2019年10月~2020年10月我院收治的162例ICD患者,均接受血管内支架植入治疗,根据术后是否发生脑梗死分为未合并脑梗死组、合并脑梗死组。比较两组患者的病历资料,采用Logistic回归分析发生脑梗死的的影响因素。入组患者均接受HRMRI、CVUS检测,比较两种影像学方式对于ICD患者发生脑梗死的预测价值。结果:162例患者经脑部CT及磁共振成像检查确诊脑梗死32例,无脑梗死130例。两组受试者高血压、手术时长、D-二聚体、C-反应蛋白比较差异有统计学意义(P<0.05)。Logistic回归分析显示高血压(OR=1.950;95%CI=1.183~3.215)、手术时长(OR=1.865;95%CI=1.085~3.203)、D-二聚体(OR=2.071;95%CI=1.162~3.692)、C-反应蛋白(OR=2.250;95%CI=1.140~4.442)均为颈内动脉夹层发生脑梗死的危险因素(P<0.05)。162例患者中,HRMRI显示212支血管夹层,CVUS显示218支血管夹层,其中有6支血管仅在CVUS上提示夹层,有14支血管仅在HRMRI上提示夹层。HRMRI联合CVUS检查预测脑梗死的敏感性、特异性、准确率分别为90.63%、75.38%、78.40%,其中联合检查的敏感性明显高于单独检查(P<0.05)。结论:D-二聚体、C反应蛋白、高血压、手术时长均为颈内动脉夹层患者术后发生脑梗死的危险因素。HRMRI联合血管超声可提高颈内动脉夹层患者发生脑梗死的预测价值。

162 ICD patients admitted from October 2019 to October 2020 were selected and divided into the group without cerebral infarction and the group with cerebral infarction according to the occurrence of postoperative cerebral infarction.All the enrolled patients received HRMRI and CVUS tests.The predictive value of the two imaging methods for cerebral infarction in ICD patients was compared,and the influencing factors of cerebral infarction were analyzed by Logistic regression.Cerebral infarction was confirmed in 32 of 162 patients by brain CT and magnetic resonance imaging,and in 130 cases without cerebral infarction.There were statistically significant differences in hypertension,operation duration,D-dimer and C-reactive protein between the two groups(P<0.05).Logistic regression analysis showed that hypertension(OR=1.950;95%CI=1.183—3.215),operative duration(OR=1.865;95%CI=1.085—3.203),D-dimer(OR=2.071;95%CI=1.162—3.692),creactive protein(OR=2.250;95%CI=1.140—4.442)were risk factors for cerebral infarction in ICD(P<0.05).The sensitivity,specificity and accuracy of HRMRI combined with CVUS in predicting cerebral infarction were 90.63%,75.38%and 78.40%,respectively.The sensitivity of combined examination was significantly higher than that of single examination(P<0.05).It can be indicated that HRMRI combined with vascular ultrasound has a good predictive value for cerebral infarction in ICD patients;D-dimer,C-reactive protein,hypertension,and duration of surgery are all risk factors for cerebral infarction in patients with internal carotid artery dissection after surgery.