MRI-DWI与PWI测量参数对老年急性缺血性脑卒中尿激酶溶栓治疗的预后评估价值

The Value of MRI-DWI and PWI Measurement Parameters in Evaluating the Prognosis of Urokinase Thrombolytic Therapy in Elderly Patients with Acute Ischemic Stroke

目的分析核磁共振弥散加权成像(MRI-DWI)与灌注加权成像(PWI)测量参数对老年急性缺血性脑卒中尿激酶溶栓治疗的预后评估价值。方法以行尿激酶溶栓治疗的老年急性脑卒中患者189例(研究组),以同时期来本院体检中心体检的健康志愿者98例(对照组),两组均行MRI-DWI与PWI检查。比较两组患者MRI-DWI与PWI测量参数。将研究组患者根据院内28 d内是否发生死亡分为死亡组和存活组,比较死亡组和存活组患者MRI-DWI与PWI测量参数以及其他可能影响因素。患者预后分析采用Logistic回归分析与受试者工作特征(ROC)曲线。结果研究组ADC、r CBF低于对照组(P<0.05),TTP高于对照组(P<0.05)。死亡组患者入院时格拉斯哥昏迷(GCS)评分、ADC、r CBF低于存活组(P<0.05),TTP水平高于存活组(P<0.05)。GCS评分、CRP、ADC、r CBF、TTP水平均是影响老年急性缺血性脑卒中患者发生死亡的危险因素(P<0.05)。ADC、r CBF、TTP三者联合预测老年急性缺血性脑卒中患者发生死亡的AUC为0.816均高于三者单独预测。结论老年急性脑卒中患者ADC、r CBF降低,TTP升高,且均是影响其发生死亡的危险因素。ADC、r CBF、TTP三者联合对行尿激酶治疗的老年急性脑卒中患者预后具有较高的预测价值。

Objective To analyze the prognostic value of MRI-DWI and perfusion weighted imaging(PWI)measurement parameters for urokinase thrombolytic therapy in elderly patients with acute ischemic stroke.Methods 189 elderly patients with acute cerebral stroke who received urokinase thrombolysis(study group),and 98 healthy volunteers who came to the physical examination center of our hospital during the same period(control group),both groups underwent MRI-DWI and PWI examinations MRI-DWI and PWI measurement parameters were compared between the two groups.The patients in the study group were divided into the death group and the survival group according to whether death occurred within 28 days in the hospital,and the MRI-DWI and PWI measurement parameters and other possible influencing factors of the patients in the death group and the survival group were compared.The prognosis of patients was analyzed using Logistic regression analysis and receiver operating characteristic(ROC)curve.Results The ADC and rCBF levels of the study group were lower than those of the control group(P<0.05),and the TTP level was higher than that of the control group(P<0.05).The Glasgow coma(GCS)score,ADC and rCBF levels of patients in the death group were lower than those in the survival group(P<0.05),and the levels of TTP were higher than those in the survival group(P<0.05).GCS score,CRP,ADC,rCBF and TTP levels were all risk factors for death in elderly patients with acute ischemic stroke(P<0.05).The AUC of ADC,rCBF,and TTP combined to predict death in elderly patients with acute ischemic stroke was 0.816,which was higher than that of the three alone.Conclusion The decrease of ADC and rCBF and the increase of TTP in elderly patients with acute stroke are the risk factors of death.The combination of ADC,rCBF and TTP has high predictive value for the prognosis of elderly patients with acute stroke treated with urokinase.