头颅CTA联合CTP在急性脑梗死溶栓后出血性转化预测中的应用价值分析

Application value analysis of cranial CTA combined with CTP in predicting hemorrhagic transformation after thrombolysis in acute cerebral infarction

目的探讨头颅CT血管造影(CTA)联合CT灌注扫描(CTP)在急性脑梗死溶栓后出血性转化(HT)预测中的应用价值。方法选择30例急性脑梗死溶栓后HT患者作为观察组,同期60例急性脑梗死溶栓后未发生HT患者作为对照组,均行头颅CTA联合CTP检查。比较两组患者的临床资料[性别、年龄、梗死面积、美国国立卫生研究院卒中量表(NIHSS)评分、发病时间、体质量指数(BMI)]、脑血流动力学指标[脑血容量(CBV)、脑血流量(CBF)、平均通过时间(MTT)、达峰时间(TTP)、血管表面通透性(PS)];采用多因素Logistic回归分析急性脑梗死溶栓后HT的影响因素;绘制受试者工作特征曲线(ROC曲线),分析单一CBV、CBF、MTT、TTP、PS以及头颅CTA联合CTP的预测价值(敏感性、特异性)。结果观察组年龄(68.74±9.82)岁、NIHSS评分(16.85±1.74)分均高于对照组的(60.58±10.04)岁、(8.93±0.79)分,梗死面积(65.78±7.89)mm2大于对照组的(46.57±5.68)mm2,差异具有统计学意义(P<0.05);两组性别、发病时间、BMI比较差异无统计学意义(P>0.05)。观察组CBV(2.50±0.74)ml/100 g、CBF(46.31±6.89)ml/(100 g·min)低于对照组的(2.95±0.76)ml/100 g、(60.21±12.40)ml/(100 g·min),MTT(16.35±5.08)s、TTP(24.65±6.02)s长于对照组的(12.29±5.34)、(20.07±3.24)s,PS(2.38±1.29)ml/(100 g·min)高于对照组的(0.81±1.16)ml/(100 g·min),差异具有统计学意义(P<0.05)。多因素Logisitic回归分析显示:梗死面积、CBV、CBF、MTT、TTP、PS均是急性脑梗死溶栓后HT的影响因素(P<0.05)。ROC曲线分析显示:单一CBV、CBF、MTT、TTP、PS预测的敏感性、特异性较低,CTA联合CTP预测的敏感性、特异性较高,分别为98.4%、98.8%。结论头颅CTA联合CTP在急性脑梗死溶栓后HT预测中的应用价值显著。

Objective To discuss the application value analysis of cranial CT angiography(CTA)combined with CT perfusion(CTP)in predicting hemorrhagic transformation after thrombolysis(HT)in acute cerebral infarction.Methods 30 patients with HT after thrombolysis of acute cerebral infarction were selected as the observation group,and 60 patients without HT after thrombolysis of acute cerebral infarction were selected as the control group.CTA combined with CTP was performed in all patients.Both groups were compared in terms of clinical data[gender,age,infarct size,National Institutes of Health Stroke Scale(NIHSS)score,time of onset,body mass index(BMI)],cerebral hemodynamics indexes[cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT),time to peak(TTP),and permeability surface(PS)].Multi-factor Logistic regression was used to analyze the factors influencing HT after thrombolysis in acute cerebral infarction;receiver operating characteristic(ROC)curves were drawn to analyze the predictive value(sensitivity,specificity)of single CBV,CBF,MTT,TTP,PS,and cranial CTA combined with CTP.Results The age(68.74±9.82)years and NIHSS score(16.85±1.74)points in the observation group were higher than(60.58±10.04)years and(8.93±0.79)points in the control group;the infarct size(65.78±7.89)mm2 in the observation group was greater than(46.57±5.68)mm2 in the control group;the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of gender,time of onset,and BMI(P>0.05).The CBV(2.50±0.74)ml/100 g and CBF(46.31±6.89)ml/(100 g·min)in the observation group were lower than(2.95±0.76)ml/100 g and(60.21±12.40)ml/(100 g·min)in the control group;the MTT(16.35±5.08)s and TTP(24.65±6.02)s in the observation group were longer than(12.29±5.34)and(20.07±3.24)s in the control group;the PS(2.38±1.29)ml/(100 g·min)in the observation group was higher than(0.81±1.16)ml/(100 g·min)in the control group;the differences were statistically significant(P<0.05).Multi-factor Logisitic regression analysis showed that infarct size,CBV,CBF,MTT,TTP,and PS were all influential factors of HT after thrombolysis in acute cerebral infarction(P<0.05).ROC curve analysis showed that the sensitivity and specificity of single CBV,CBF,MTT,TTP,and PS prediction were low,and the sensitivity and specificity of CTA combined with CTP were high,which were 98.4%and 98.8%,respectively.Conclusion Cranial CTA combined with CTP is of great value in predicting HT after thrombolysis in acute cerebral infarction.