头颈部CTA联合毛细血管指数评分对大脑中动脉闭塞急性脑梗死患者预后评估价值研究

The Prognostic Value of Head and NeckCTA and Capillary Index Score in Patientswith Middle Cerebral Artery Occlusion

目的探讨头颈部CT血管造影(CTA)联合毛细血管指数评分(CIS)对大脑中动脉(MCA)闭塞急性脑梗死(ACI)患者的预后评估价值。方法选取2019年1月~2022年5月我院106例MCA狭窄闭塞ACI患者为研究对象,治疗前均行头颈部CTA检查、数字减影血管造影完成CIS,根据治疗3个月后改良Rankin量表(mRS)评分分为预后不良组(n=49,mRS评分>2分)与预后良好组(n=57,mRS≤2分)。比较两组CTA特征、CIS,多因素logistic回归分析CTA特征、CIS对MCA闭塞ACI患者预后的影响,ROC曲线分析预测价值。结果两组斑块类型、软斑块表面伴钙化环的混斑钙化环厚径、软斑厚径及侧支循环分级比较,差异有统计学意义(P<0.05);预后不良组P-CIS比例高于预后良好组(P<0.05);Logistic回归分析显示,软斑或混斑、侧支循环分级为不良、P-CIS均为MCA闭塞ACI患者预后不良的独立危险因素(P<0.05);ROC曲线显示,斑块类型、侧支循环分级、CIS联合预测MCA闭塞ACI患者预后的AUC值为0.802,高于单独预测。结论头颈部CTA联合CIS可有效评估MCA闭塞ACI患者预后情况,为临床决策提供参考。

Objective To explore the prognostic evaluation value of head and neck CT angiography(CTA)combined with capillary index score(CIS)in patients with acute cerebral infarction(A C A)with middle cerebral artery(MCA)occlusion.Methods 106 patients with MCA occlusion ACI from January 2019 to May 2022 were selected with CTA examination and CIS according to the modified Rankin scale(mRS)score(n=49,mRS score>2)and good prognosis(n=57,mRS 2).Comparing the two groups of CTA characteristics,CIS,the multivariate logistic regression analyzed the effect of CTA characteristics and CIS on the prognosis of MCA-occluded ACI patients,and the predictive value of the ROC curve analysis.Results Comparison of the grades of mixed plaque calcification ring thickness diameter,soft plaque thickness diameter and collateral circulation,The difference was statistically significant(P<0.05);The proportion of P-CIS in the poor prognosis group was higher than that in the group with good prognosis(P<0.05);The Logistic regression analysis revealed that,Soft spots or mixed spots,poor collateral circulation grade,and P-CIS were all independent risk factors for the poor prognosis of patients with MCA occlusion and ACI(P<0.05);The ROC curve shows that,Plaque type,grade of collateral circulation,and CIS combined the AUC value for predicting the outcome of patients with MCA occlusion and ACI was 0.802,Higher than that predicted alone.Conclusion CTA of head and neck neck and CIS can effectively evaluate the prognosis of patients with MCA occlusion and ACI,and provide a reference for clinical decision-making.