HR-MRI联合血清bFGF、ANGPTL4对大脑中动脉狭窄性脑梗死患者的预后价值

The Prognostic Value of HR-MRI Combined with Serum bFGF and ANGPTL4 in Patients with Middle Cerebral Arter y Stenosis Induced Cerebral Infarction

目的探讨高分辨率磁共振成像(HR-MRI)联合血清碱性成纤维生长因子(bFGF)、血管生成素样蛋白4(ANGPTL4)对大脑中动脉狭窄(MCAS)性脑梗死患者的预后预测价值。方法纳入2021年10月-2023年3月本院确诊的发病24 h内的MCAS性脑梗死患者78例,依据mRS量表分为预后良好组(42例)与预后不良组(36例)。依次对患者进行头颅常规DWI、3D-TOF、HR-MRI序列扫描,并记录参数。采集静脉血并检测血清bFGF、ANGPTL4水平。比较2组HR-MRI参数及血清bFGF、ANGPTL4水平差异,并分析MCAS性脑梗死患者预后影响因素。ROC曲线明确HR-MRI参数联合血清bFGF、ANGPTL4对MCAS性脑梗死患者预后预测价值。结果预后良好组患者HR-MRI参数中最狭窄处管腔面积(2.58_0.51)mm^(2)及血清bFGF(18.63_4.25)pg/mL、ANGPTL4(14.26_3.05)ng/mL水平高于预后不良组[(2.04_0.40)mm^(2)、(11.44_3.57)pg/mL、(9.38_2.14)ng/mL],T2WI(0.74_0.15)和T1WI信号强度指数(0.78_0.14)、斑块强化率(53.09_6.26)%低于预后不良组[(0.97_0.24)、(0.94_0.17)、(57.35_6.04)%](P<0.05)。回归分析显示,T2WI信号强度指数(OR=1.915)、血清bFGF(OR=0.762)、T1WI信号强度指数(OR=2.094)、ANGPTL4(OR=0.736)、最狭窄处管腔面积(OR=0.809)是MCAS性脑梗死患者预后不良的影响因素(P<0.05)。ROC结果显示,最狭窄处管腔面积、T2WI和T1WI信号强度指数单独及联合预测MCAS脑梗死患者预后不良的AUC为0.798、0.771、0.806、0.906,血清bFGF、ANGPTL4预测MCAS性脑梗死患者预后不良的AUC为0.873、0.821,而HR-MRI参数联合血清bFGF、ANGPTL4预测的AUC为0.972,敏感度为91.70%,优于单一指标检测。结论HRMRI参数、血清bFGF和ANGPTL4水平在评估MCAS性脑梗死患者预后中有重要作用,联合检测的预测效能更高,可为临床预测MCAS性脑梗死患者预后提供参考。

Objective To explore the prognostic value of high-resolution magnetic resonance imaging(HR-MRI)combined with serum basic fibroblast growth factor(bFGF)and angiopoietin-like protein 4(ANGPTL4)in patients with middle cerebral artery stenosis(MCAS)induced cerebral infarction.Methods A total of 78 patients with MCAS induced cerebral infarction diagnosed in our hospital within 24 hours of onset from October 2021 to March 2023 were included in the study.They were grouped into a good prognosis group(42 cases)and a poor prognosis group(36 cases)based on the mRS scale.Routine DWI,3D-TOF,and HR-MRI sequence scans of the patient's skull were performed in sequence,and the parameters were recorded.Venous blood was collected and serum bFGF and ANGPTL4 levels were detected.The differences in HR-MRI parameters and serum bFGF and ANGPTL4 levels were compared between two groups,and analyze the prognostic factors of MCAS induced cerebral infarction patients.ROC curve was used to clarify the prognostic value of HR-MRI parameters combined with serum bFGF and ANGPTL4 in patients with MCAS induced cerebral infarction.Results In the HR-MRI parameters,the narrowest lumen area(2.58_0.51)mm^(2) and serum bFGF(18.63_4.25)pg/mL,ANGPTL4(14.26_3.05)ng/mL levels in good prognosis group were higher than those in poor prognosis group[(2.04_0.40)mm^(2),(11.44_3.57)pg/mL,and (9.38_2.14)ng/mL],the signal intensity indexes of T2WI(0.74_0.15)and T1WI(0.78_0.14),and the plaque enhancement rate(53.09_6.26)%were lower than those in the poor prognosis group[(0.97_0.24),(0.94_0.17),and(57.35_6.04)%](P<0.05).Regression analysis showed that T2WI signal intensity index(OR=1.915),serum bFGF(OR=0.762),T1WI signal intensity index(OR=2.094),ANGPTL4(OR=0.736),and the narrowest lumen area(OR=0.809)were factors affecting the poor prognosis of MCAS induced cerebral infarction patients(P<0.05).ROC results showed that the AUCs for predicting poor prognosis in patients with MCAS induced cerebral infarction by the narrowest lumen area,T2WI,and T1WI signal intensity indices alone and in combination were 0.798,0.771,0.806,and 0.906.The AUCs for predicting poor prognosis in patients with MCAS induced cerebral infarction by serum bFGF and ANGPTL4 were 0.873 and 0.821,the combined prediction of HR-MRI parameters with serum bFGF and ANGPTL4 had a AUC of 0.972,with a sensitivity of 91.70%,which was superior to single indicator detection.Conclusion HRMRI parameters,serum bFGF and ANGPTL4 levels play an important role in evaluating the prognosis of MCAS induced cerebral infarction patients.The combined detection has higher predictive efficacy and can provide reference for clinical prediction of the prognosis of MCAS induced cerebral infarction patients.