脑氧摄取分数与颈动脉支架术后脑高灌注综合征的相关性分析

CORRELATION BETWEEN CEREBRAL OXYGEN EXTRACTION FRACTION AND CEREBRAL HYPERPERFUSION SYNDROME AFTER CAROTID ARTERY STENTING

目的探讨颈内动脉支架置入术(CAS)患者脑氧摄取分数(cOEF)的变化与CAS后脑高灌注综合征(cerebral hyperperfusion syndrome,CHS)发生的关系。方法选取2015年12月—2019年8月于我院行CAS的颈动脉狭窄患者212例,根据术后是否发生CHS分为正常组(175例)及高灌注组(37例),比较两组患者的一般资料及术前、术后cOEF值,通过logistic回归模型分析CAS后患者CHS发生的影响因素,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)。结果两组患者术前颈动脉狭窄程度、术前及术后cOEF比较,差异有显著性(t=2.289~5.944,P<0.05);logistic回归分析结果显示,术前颈动脉狭窄程度、术前cOEF和术后cOEF是CHS发生的影响因素(P<0.001);ROC曲线分析显示,术前cOEF预测CHS的AUC为0.734(cut-off=0.442),术后cOEF预测CHS的AUC为0.775(cut-off=0.521)。结论CAS术前cOEF>0.442及术后cOEF>0.521为CAS后患者发生CHS的危险因素,围术期监测cOEF对CHS的预防具有重要临床意义。

Objective To investigate the relationship between changes in cerebral oxygen extraction fraction(cOEF)and the occurrence of cerebral hyperperfusion syndrome(CHS)after carotid artery stenting(CAS).Methods A total of 212 patients with carotid artery stenosis who underwent CAS from December 2015 to August 2019 were included.They were divided into normal group(175 cases)and high-perfusion group(37 cases)based on the occurrence of CHS after surgery.General information and preoperative and postoperative cOEF values were compared between the two groups.The influencing factors for CHS after CAS were analyzed using logistic regression models,and receiver operating characteristic(ROC)curves were drawn to calculate the area under the curve(AUC).Results There were significant differences in preoperative CAS degree,preoperative cOEF,and pos-toperative cOEF between the two groups(t=2.289-5.944,P<0.05).The logistic regression analysis showed that preoperative CAS degree,preoperative cOEF,and postoperative cOEF were influence factors for CHS(P<0.001).According to the ROC curves,the AUC values for the prediction of CHS by preoperative cOEF and postoperative cOEF were 0.734(cut-off=0.442)and 0.775(cut-off=0.521),respectively.Conclusion Preoperative cOEF>0.442 and postoperative cOEF>0.521 are risk factors for CHS after CAS,and cOEF monitoring during the perioperative period is of great clinical significance in CHS prevention.