多模态MRI参数联合Aβ1-42蛋白对缺血性脑卒中后认知损害的预测价值

Predictive value of multimodal MRI parameters combined with Aβ1⁃42 protein in cogni⁃tive impairment after ischemic stroke

目的 分析研究多模态磁共振成像(MRI)参数联合Aβ1-42蛋白对缺血性脑卒中后认知损害的预测价值。方法 选取2020年1月至2022年12月辽宁省健康产业集团阜新矿总医院收治的缺血性脑卒中后存在认知损害患者为损害组(n=116),另选同期缺血性脑卒中无认知损害患者分为无损害组(n=116)。比较两组的多模态MRI参数(WMLs评分、WMLs体积、CMBs数量、FA值、ADC值)与Aβ1-42蛋白水平;采用多因素Logistic回归分析缺血性脑卒中后认知损害的影响因素,并采用ROC曲线分析多模态MRI参数和Aβ1-42蛋白水平对缺血性脑卒中后认知损害的预测价值。结果 单因素分析结果显示,WMLs评分、WMLs体积、CMBs数量、基底节区FA值、顶叶FA值、额颞叶FA值与Aβ1-42蛋白水平均是缺血性脑卒中后认知损害的影响因素,差异均具有统计学意义(P<0.05);多因素Logistic回归分析显示,WMLs评分升高(OR=1.702)、WMLs体积增大(OR=2.195)、CMBs数量增加(OR=1.626)、基底节区FA值降低(OR=2.143)、顶叶FA值降低(OR=2.121)、额颞叶FA值降低(OR=2.098)和Aβ1-42蛋白水平下降(OR=2.134)均是缺血性脑卒中后认知损害的独立危险因素(P<0.05)。ROC曲线分析显示,WMLs评分、WMLs体积、CMBs数量、基底节区FA值、顶叶FA值、额颞叶FA值、Aβ1-42蛋白水平及联合检测的曲线下面积(AUC)分别为0.924、0.826、0.876、0.681、0.740、0.771、0.678、0.990,联合检测优于单一检测(P<0.05)。结论 多模态MRI参数、Aβ1-42蛋白与缺血性脑卒中后认知损害相关,联合检测对缺血性脑卒中后认知损害具有较好的预测价值。

Objective To investigate the predictive value of multimodal magnetic resonance im-aging(MRI)parameters combined with Aβ1-42 protein in cognitive impairment after ischemic stroke.Methods Patients with cognitive impairment after ischemic stroke admitted to Fuxinmine General Hospital of Liaoning Health Industry Group from January 2020 to December 2022 were selected as the impairment group(n=116),and patients with no cognitive impairment during the same period of ischemic stroke were di-vided into the non-impairment group(n=116).Multimodal MRI parameters(WMLs score,WMLs volume,CMBs number,FA value,ADC value)and Aβ1-42 protein levels were compared between the two groups.Multivariate Logistic regression was used to analyze the influencing factors of cognitive impairment after isch-emic stroke,and ROC curve was used to analyze the predictive value of multimodal MRI parameters and Aβ1-42 protein level for cognitive impairment after ischemic stroke.Results Univariate analysis showed that WMLs score,WMLs volume,CMBs number,basal ganglia FA value,parietal FA value,frontotemporal FA value and Aβ1-42 protein level were all influential factors of cognitive impairment after ischemic stroke,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that WMLs score increased(OR=1.702),WMLs volume increased(OR=2.195),CMBs number increased(OR=1.626),FA value in basal ganglia decreased(OR=2.143),FA value in parietal lobe decreased(OR=2.121),FA value in frontotemporal lobe decreased(OR=2.098)and Aβ1-42 Decreased protein level(OR=2.134)was an independent risk factor for cognitive impairment after ischemic stroke(P<0.05).ROC curve analysis showed that,WMLs score,WMLs volume,number of CMBs,FA value in basal ganglia,FA value in pari-etal lobe,FA value in frontotemporal lobe,Aβ1-42 protein level and the area under the curve(AUC)of com-bined detection were 0.924,0.826,0.876,0.681,0.740,0.771,0.678,0.990,respectively.Combined detec-tion was better than single detection(P<0.05).Conclusion Multimodal MRI parameters and Aβ1-42 protein are associated with cognitive impairment after ischemic stroke,and combined detection has good predictive value for cognitive impairment after ischemic stroke.