基于HR-MRI颅内血管斑块参数与老年初发和再发脑梗死患者预后的相关性分析

Correlation Analysis of Intracranial Vascular Plaque Parameters Basedon HR-MRI and Prognosis of Patients with Early-onsetand Re-onset Cerebral Infarction

比较老年初发和再发脑梗死患者高分辨率磁共振成像(HR-MRI)的颅内血管斑块参数差异,并探讨相关颅内血管斑块特征参数与患者预后的关系。回顾性选取老年脑梗死患者179例,患者治疗前均行HR-MRI检查,根据住院原因分为初发组和再发组,并比较两组的HR-MRI颅内血管斑块参数差异;于患者治疗3个月后的随访复查,根据患者临床结局分为预后良好组和预后不良组,采用单因素及多因素Logistic回归分析HR-MRI颅内血管斑块参数及其他因素与脑梗死患者预后关系,并使用受试者操作特征(ROC)曲线分析相关HR-MRI颅内血管斑块参数预测脑梗死患者预后不良的效能。结果显示初发与再发组脑梗死组的斑块重构方式,偏心指数无显著性差异(P>0.05),两组的颅内血管斑块面积、斑块负荷、斑块出血占比、斑块强化程度比较,存在显著性差异(P<0.05)。单因素和多因素结果显示:再发脑梗死、梗死面积、美国国立卫生研究院卒中量表(NIHSS)评分升高、斑块负荷增大、斑块内出血是脑梗死患者预后不良的独立影响因素。基于HR-MRI的斑块负荷、斑块内出血、斑块强化程度预测概率预测脑梗死患者预后不良风险的AUC分别为0.658、0.604、0.616,特异度分别为77.8%、76.9%、82.9%;联合预测的AUC为0.727,敏感度为79.0%,特异度为53.8%。以上表明初发和再发急性脑梗死患者的颅内血管斑块特征存在差异,颅内血管斑块特征与脑梗死患者预后密切相关,通过HR-MRI检查脑梗死的颅内血管斑块特征有助于预测脑梗死患者的预后。

The differences of intracranial vascular plaque parameters between high-resolution magnetic resonance imaging(HR-MRI)in elderly patients with primary and recurrent cerebral infarction were compared,and the relationship between the characteristic parameters of intracranial vascular plaque and the prognosis of patients was discussed.A total of 179 elderly patients with cerebral infarction were retrospectively selected.All patients underwent HR-MRI examination before treatment.According to the cause of hospitalization, the patients were divided into primary group and recurrent group. The differences of HR-MRI intracranial vascular plaque parameters between the two groups were compared. According to the clinical outcomes, the patients were divided into good prognosis group and poor prognosis group. Univariate and multivariate Logistic regression analysis were used to analyze the relationship between HR-MRI intracranial vascular plaque parameters and other factors and the prognosis of patients with cerebral infarction. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of HR-MRI intracranial vascular plaque parameters in predicting the poor prognosis of patients with cerebral infarction. The results indicate there was no significant difference in plaque remodeling and eccentricity index between the initial and recurrent cerebral infarction groups ( P >0.05). There were significant differences in intracranial vascular plaque area, plaque load, plaque hemorrhage ratio and plaque enhancement degree between the two groups ( P <0.05). Univariate and multivariate results showed that recurrent cerebral infarction, infarct size, increased NIHSS score, increased plaque load, and intraplaque hemorrhage were independent influencing factors for poor prognosis in patients with cerebral infarction. The AUC of plaque burden, intraplaque hemorrhage, plaque enhancement and predictive probability based on HR-MRI in predicting the risk of poor prognosis in patients with cerebral infarction were 0.658, 0.604 and 0.616, respectively, and the specificities were 77.8%, 76.9% and 82.9%, respectively. The combined prediction AUC was 0.727, the sensitivity was 79.0%, and the specificity was 53.8%. The above findings the characteristics of intracranial vascular plaques in patients with primary and recurrent acute cerebral infarction are different. The characteristics of intracranial vascular plaques are closely related to the prognosis of patients with cerebral infarction. The characteristics of intracranial vascular plaques in cerebral infarction by HR-MRI are helpful to predict the prognosis of patients with cerebral infarction.