CTP灌注参数联合脑电图对aSAH继发癫痫及预后的价值分析

Predictive value of CTP parameters combined with electroencephalogram for epilepsy secondary to aSAH and the prognosis

目的:分析脑CT灌注成像(CTP)参数联合脑电图对动脉瘤性蛛网膜下腔出血(aSAH)继发癫痫及其预后的预测价值。方法:选取aSAH患者78例,其中CTP联合脑电图检查40例(联合组),单独CTP检查38例(对照组),比较两组动态EEG Young分级、脑血管痉挛与痫样发作检出情况,比较发生与未发生脑血管痉挛者的CTP参数、痫样发作与未发作者CTP参数、预后,分析单独CTP、CTP联合脑电图对预后的预测价值。结果:联合组EEG Young分级Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ型分别3、5、19、11、2例;联合组脑血管痉挛、痫样发作检出率高于对照组(P<0.05);两组中发生脑血管痉挛者脑血流量、脑血容量均较未发生脑血管痉挛者低,而达峰时间、平均通过时间延长(P<0.05);联合组中痫样发作者的脑电图类型构成与未发作者存在差异(P<0.05),痫样发作者以Ⅲ、Ⅳ型为主,非发作者以Ⅱ型为主;痫样发作者改良Rankin评分高于非发作者(P<0.05),联合组评估预后的准确率高于对照组,而错误率低于对照组(P<0.05)。结论:与单纯CTP相比,CTP联合脑电图对aSAH患者继发癫痫及预后的预测价值更高,可在临床推广应用。

Objective To analyze the value of cerebral CT perfusion imaging(CTP) parameters combined with electroencephalogram(EEG) to predict epilepsy secondary to aneurysmal subarachnoid hemorrhage(aSAH) and the prognosis. Methods A total of 78 patients with aSAH were enrolled in the study, including 40 patients receiving CTP combined with EEG examination(combined group), and 38 receiving CTP alone(control group). The dynamic EEG Young type and the detection rates for cerebral vasospasm and epileptiform seizures were compared between two groups. The CTP parameters were compared between patients with and without cerebral vasospasm, and the EEG Young type composition and prognosis were compared patients with and without epileptiform seizures. The predictive value of CTP alone and CTP combined with EEG for the prognosis was analyzed. Results There were 3, 5, 19, 11, and 2 cases of EEG Young typesⅠ , Ⅱ,Ⅲ, Ⅳ, and V in the combined group. The detection rates for cerebral vasospasm and epileptiform seizures in the combined group were higher than those in control group(P<0.05). Compared with patients without cerebral vasospasm, those with cerebral vasospasm had smaller cerebral blood flow and cerebral blood volume, longer time to peak and mean transit time(P<0.05). In the combined group, the composition of EEG types between patients with and without epileptiform seizures were significantly different(P<0.05). Types Ⅲ and Ⅳ predominated in patients with epileptiform seizures, while type Ⅱ in those without epileptiform seizures. The modified Rankin scale scores of patients with epileptiform seizures were higher than those of patients without epileptiform seizures(P<0.05). Compared with control group, the combined group had higher accuracy rate in prognosis assessment(P<0.05). Conclusion Compared with CTP alone, CTP combined with EEG has high predictive value for epilepsy secondary to aSAH and its prognosis, worthy of clinical application.