ASPECTS评分与CT灌注成像参数在急性缺血性脑卒中患者预后评估中的应用价值

Application of ASPECTS Score and CT Perfusion Imaging Parameters in Prognostic Evaluation of Acute Ischemic Stroke Patients

【目的】探讨Alberta卒中项目早期CT评分(ASPECTS)与CT灌注成像参数(CTP)在急性缺血性脑卒中(AIS)患者预后评估中的价值。【方法】65例AIS患者,依据预后情况分为预后良好组(36例)和预后不良组(29例)。比较两组患者临床资料、美国国立卫生院卒中量表(NIHSS)评分、脑卒中类型、ASPECTS评分和CTP,并对两组有差异的数据行多因素logistic回归分析,明确AIS患者预后的影响因素。采用受试者工作特征(ROC)曲线分析脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)预测AIS患者预后不良的价值。【结果】预后不良组NIHSS评分>7分、多发性脑卒中、心源性脑栓塞、脑动脉炎、ASPECTS评分≤7分的患者占比显著高于预后良好组(P<0.05);预后不良组的CBF、CBV、MTT显著低于预后良好组(P<0.05)。ROC分析显示:CBF、CBV、MTT均能用于AIS患者预后不良的预测,曲线下面积分别为0.828、0.992、0.754(均P<0.05)。多因素Logistic回归分析显示,NIHSS评分>7分、多发性脑卒中、心源性脑栓塞、脑动脉炎、ASPECTS评分≤7分、CBF≤12.870 mL/(100 g·min)、CBV≤8.890 mL/100 g、MTT≤16.425 s是影响AIS患者预后的危险因素(P<0.05)。【结论】NIHSS评分、多发性脑卒中、心源性脑栓塞、脑动脉炎、ASPECTS评分、CTP参数均是影响AIS患者预后的因素,临床应予以重视。

【Objective】To explore the value of early CT score(ASPECTS)and CT perfusion imaging parameters(CTP)in the prognosis evaluation of patients with acute ischemic stroke(AIS)in the Alberta Stroke Project.【Methods】A total of 65 AIS patients were divided into a good prognosis group of 36 cases and a poor prognosis group of 29 cases based on their prognosis.We compared the clinical data,National Institutes of Health Stroke Scale(NIHSS)scores,stroke types,ASPECTS scores,and CTP between two groups of patients,and performed multiple logistic regression analysis on the data with differences between the two groups to identify the factors affecting the prognosis of AIS patients.The value of predicting poor prognosis in AIS patients was predicted by analyzing the receiver operating characteristic(ROC)curve of cerebral blood flow(CBF),cerebral blood volume(CBV),and mean transit time(MTT).【Results】The proportion of patients in the poor prognosis group with NIHSS score>7,multiple stroke,cardioembolic stroke,cerebral arteritis,and ASPECTS score≤7 was significantly higher than that in the good prognosis group(P<0.05);The CBF,CBV,and MTT of the poor prognosis group were significantly lower than those of the good prognosis group(P<0.05).ROC analysis showed that CBF,CBV,and MTT can all be used for predicting poor prognosis in AIS patients,with areas under the curves of 0.828,0.992,and 0.754,respectively(all P<0.05).Multivariate logistic regression analysis showed that NIHSS score>7,multiple stroke,cardioembolic stroke,cerebral arteritis,ASPECTS score≤7,CBF≤12.870 mL/100 g/min,CBV≤8.890 mL/100 g,MTT≤16.425 s were risk factors affecting the prognosis of AIS patients(P<0.05).【Conclusion】NIHSS score,multiple stroke,cardioembolic stroke,cerebral arteritis,ASPECTS score,and CTP parameters are all factors that affect the prognosis of AIS patients,and should be taken seriously in clinical practice.