探讨头颅CT血管造影联合CT灌注扫描在急性脑梗死溶栓后出血性转化预测中的应用价值

Application Value of Head CT Angiography Combined with CT Perfusion Scanning in Prediction of HemorrhagicTransformation after Thrombolysis in Acute Cerebral Infarction

目的:探讨头颅CT血管造影(CTA)联合CT灌注扫描(CTP)在急性脑梗死溶栓后出血性转化(HT)预测中的应用价值。方法:选取2020年5月—2023年5月东海县人民医院收治的急性脑梗死溶栓后HT患者35例作为观察组,另外选取同期急性脑梗死溶栓后未发生HT患者70例作为对照组。患者均行CTA联合CTP检查。统计两组相关资料、脑血流动力学指标、急性脑梗死溶栓后HT的多因素Logistic回归分析、急性脑梗死溶栓后HT的预测价值。结果:两组年龄、身体质量指数比较,差异无统计学意义(P>0.05);观察组梗死面积大于对照组,美国国立卫生研究院卒中量表评分(NIHSS)低于对照组,差异有统计学意义(P<0.05);观察组脑血容量(CBV)、脑血流量(CBF)低于对照组,平均流通时间(MTT)、达峰时间(TTP)、渗透性表面乘积(PS)高于对照组,差异有统计学意义(P<0.05);梗死面积、CBV、CBF、MTT、TTP、PS、NIHSS评分是溶栓后HT的影响因素(P<0.05)。ROC曲线分析,CTA联合CTP的预测敏感性和特异性高于脑血流动力学指标(P<0.01)。结论:对急性脑梗死溶栓后HT预测使用CTA联合CTP具有较高的临床价值。

Objective:To investigate the application value of head CT angiography(CTA)combined with CT perfusion scanning(CTP)in the prediction of hemorrhagic transformation(HT)after thrombolysis in acute cerebral infarction.Methods:Thirty-five patients with HT after thrombolysis in acute cerebral infarction treated in Donghai County People's Hospital from May 2020 to May 2023 were selected as the observation group,and another seventy patients without HT after thrombolysis in acute cerebral infarction during the same period were selected as the control group.All patients underwent CTA combined with CTP examination.The correlation data of the two groups,cerebral hemodynamic indexes,multifactor Logistic regression analysis of HT after thrombolysis in acute cerebral infarction,and the predictive value of HT after thrombolysis in acute cerebral infarction were analyzed.Results:There was no significant difference in age and body mass index between the two groups(P>0.05);the infarct size of the observation group was larger than that of the control group,and the score of the national institutes of health stroke scale(NIHSS)was lower than that of the control group,the differences were statistically significant(P<0.05);cerebral blood volume(CBV)and cerebral blood flow(CBF)in observation group were lower than those in control group,while mean circulation time(MTT),peak time(TTP)and permeability surface product(PS)in observation group were higher than those in control group,the differences were statistically significant(P<0.05);infarct size,CBV,CBF,MTT,TTP,PS and NIHSS scores were the influencing factors of HT after thrombolysis(P<0.05);ROC curve analysis showed that the predictive sensitivity and specificity of CTA combined with CTP were higher than those of cerebral hemodynamics(P<0.01).Conclusion:CTA combined with CTP has high clinical value in predicting HT after thrombolysis in acute cerebral infarction.