CT血管造影与大脑中动脉狭窄程度及临床预后的相关性研究

Correlation of CT Angiography with the Degree of Middle Cerebral Artery Stenosis and Clinical Prognosis

目的探讨CT血管造影(computed tomography angiography,CTA)与大脑中动脉(middle cerebral artery,MCA)狭窄程度及临床预后的相关性。方法选取2019年5月至2021年12月141例于我院行CTA检查的患者,依据CTA检查结果分为正常组(45例)和狭窄组(96例),比较患者MCA狭窄程度与斑块、侧支循环情况的关系,随访记录患者3个月的预后情况。相关性采用Spearman分析,多因素采用Logistic多元回归分析,并建立患者预后的列线图模型,评价其预后价值。结果本研究共纳入141例研究对象,其中96例MCA狭窄患者,轻度狭窄45例,中度狭窄32例,重度狭窄(包含闭塞)29例。4组在高血压史、年龄、吸烟史比例、性别、HDL-C、LDL-C、TC方面差异有统计学意义(P<0.05);随着MCA狭窄程度加重,斑块体积、斑块负荷、脂质成分、侧支循环建立频次增加,钙化程度降低;Spearman相关性分析表明MCA狭窄程度与斑块体积、斑块负荷、脂质成分以及侧支循环建立呈正相关(r=0.661、0.703、0.732、0.854,P<0.05),而与钙化程度呈负相关(r=-0.389,P<0.05);单因素分析结果显示发病至治疗时间、性别、年龄、NIHSS、CRP、Hcy、MCA狭窄程度与预后不良有关(P<0.05),进一步通过Logistic多元回归分析表明发病至治疗时间、年龄、NIHSS、CRP、Hcy、MCA狭窄程度是MCA狭窄患者预后不良发生的重要因素(P<0.05),基于以上危险因素构建预测模型,回归方程为Logit(P)=1.381+0.128*X1+1.589*X2+1.054*X3+0.353*X4-0.147*X5+0.383*X6,P=elogit(P)/(1+elogit(P)),ROC曲线显示AUC为0.817(95%CI:0.767~0.871),灵敏度为0.828,特异度为0.798。结论CTA能有效判断斑块体积、斑块内成分,操作简单,费用较低,且属于无创性检查技术,可作为MCA狭窄患者斑块类型、血管狭窄程度评估的首选检查手段,对临床预后的预测价值较高。

Objective To investigate the correlation between computed tomography angiography(CTA)and stenosis degree of middle cerebral artery(MCA)and clinical prognosis.Methods A total of 141 patients who underwent CTA examination in our hospital from May 2019 to December 2021 were selected as the research subjects.According to the results of CTA examination,they were divided into normal group(45 cases)and stricture group(96 cases).The relationship between the degree of MCA stenosis,plaque and collateral circulation in the patients was compared,and the prognosis of the patients was recorded for 3 months.The correlation was analyzed by Spearman,the multivariate was analyzed by Logistic regression,and the nomogram model of the patient's prognosis was established to evaluate its prognostic value.Results In this study,a total of 141 subjects were included,including 96 patients with MCA stenosis,45 with mild stenosis,32 with moderate stenosis,and 29 with severe stenosis(including occlusion).There were significant differences among the 4 groups in age,gender,history of hypertension,proportion of smoking history,HDL-C,LDL-C and TC(P<0.05);With the aggravation of MCA stenosis,plaque volume,plaque load,lipid composition,and the frequency of collateral circulation increased,and the degree of calcification decreased;Spearman correlation analysis showed that the degree of MCA stenosis was positively correlated with plaque volume,plaque burden,lipid composition and the establishment of collateral circulation(r=0.661,0.703,0.732,0.854,P<0.05),but negatively correlated with the degree of calcification(r=-0.389,P<0.05);Univariate analysis showed that age,gender,time from onset to treatment,NIHSS,CRP,Hcy,MCA stenosis were associated with poor prognosis(P<0.05).Further multivariate Logistic regression analysis showed that age,time from onset to treatment,NIHSS,CRP,Hcy,and MCA stenosis were independent risk factors for poor prognosis(P<0.05).A prediction model was constructed based on the above risk factors.The regression equation was as follows:Logit(P)=1.381+0.128*X1+1.589*X2+1.054*X3+0.353*X4-0.147*X5+0.383*X6,P=elogit(P)/(1+elogit(P)),ROC curve showed the AUC was 0.817(95%CI:0.767~0.871),the sensitivity was 0.828,and the specificity was 0.798.Conclusion As a non-invasive examination technique,CTA can effectively judge the plaque volume and the components in the plaque,with simple operation and low cost.The prognosis has a high predictive value.