CT灌注成像联合多时相CT血管成像对大血管闭塞急性缺血性脑卒中机械取栓术后脑水肿的预测效能分析

Analysis of predictive efficacy of CT perfusion imaging combined with multi-phase CT angiography in predicting cerebral edema after mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion

目的探讨卡莫司汀结合替莫唑胺通过调节生长因子及其受体水平治疗胶质瘤的临床价值。方法回顾性分析选取2018年9月至2020年8月本院收治的122例胶质瘤患者,均行手术切除术,根据化疗方案,将患者分成替莫唑胺组和联合联合组,比较两组患者神经功能、日常生活活动能力、生长因子及其受体水平(VEGF、EGF和EGFR)、生活质量、T淋巴细胞亚群水平、不良反应。随访至2023年7月,比较两组患者总生存期和无进展生存期。结果术后6个月,联合组患者CSS评分(17.05±4.02 vs 26.95±5.30,t=11.742,P=0.000)明显低于替莫唑胺组,联合组患者改良版Barthel指数(75.99±10.05 vs 62.15±9.12,t=7.957,P=0.000)明显高于替莫唑胺组。联合组KPS(84.28±8.41 vs 72.92±7.08,t=19.970,P=0.000)和QOL评分(44.39±4.51 vs 35.81±3.50,t=11.498,P=0.000)明显高于替莫唑胺组。联合组患者CD3+(32.55±3.14vs28.67±3.71,t=6.135,P=0.000)、CD4+(56.49±5.03vs40.84±4.51,t=17.860,P=0.000)和CD4+/CD8+(2.41±0.25vs1.12±0.17,t=33.827,P=0.000)明显高于替莫唑胺组,联合组患者CD8+(23.48±2.87vs36.71±3.81,t=21.186,P=0.000)明显低于替莫唑胺组。联合组患者VEGF(158.33±19.05 vs235.59±21.61,t=20.962,P=0.000)、EGF(48.11±4.81vs80.78±6.54,t=30.702,P=0.000)、EGFR(7.05±1.04vs11.32±3.09,t=9.727,P=0.000)和VEGFR(2.51±0.38 vs 3.10±0.23,t=10.591,P=0.000)明显低于替莫唑胺组。治疗期间,两组患者都经历恶心、呕吐、白细胞减少、血小板减少、贫血和肾毒性等副作用,而且Ⅰ~Ⅱ级副作用的发生率超过了Ⅲ~Ⅳ级,两组间的差异并无统计学意义(P>0.05)。随访3年,替莫唑胺组失访2例,联合组失访3例,联合组的3年总生存率为63.96%,高于替莫唑胺组的48.53%,但差异未见显著性差异(χ^(2)=1.847,P=0.174);联合组的3年无进展生存率为55.56%,明显高于替莫唑胺组的30.88%(χ^(2)=7.771,P=0.005)。结论卡莫司汀联合替莫唑胺应用于胶质瘤可有效改善神经功能,增强日常生活活动能力,并优化生活质量,并恢复T淋巴细胞亚群水平,延长生存期,与降低生长因子及其受体浓度有关,安全性有效,值得临床进一步研究并控制。

Objective To investigate the predictive efficacy of CT perfusion imaging combined with multi-phase CT angiography for cerebral edema after mechanical thrombectomy in acute ischemic stroke due to large vessel occlusion(AIS-LVO).Methods A total of 80 patients with AIS-LVO patients who had completed mechanical thrombectomy treatment in the Binhu District of Hefei First People's Hospital from January 2019 to October 2023 were selected.All patients underwent CT perfusion imaging and multi-phase CT angiography diagnosis before operation,and relevant imaging data was collected.Based on the occurrence of cerebral edema within 72 hours after operation,the patients were divided into the occurrence group(n=26 cases)and the non occurrence group(n=54 cases).The predictive efficacy of CT perfusion imaging combined with multi-phase CT angiography for cerebral edema after mechanical thrombectomy for AISLVO was analyzed.Results The cerebral blood volume(CBV),cerebral blood flow(CBF),and multi temporal CT angiography scores of the occurrence group before thrombectomy were lower than those of the non occurrence group,and the mean transit time(MTT)and time to peak(TTP)were higher than those of the non occurrence group,with statistical significant differences(P<0.05).Multivariate Logistic regression analysis showed that preoperative CT perfusion imaging parameters(CBV,CBF,MTT and TTP)and multi-temporal CT angiography scores of AISLVO patients were all influencing factors for postoperative cerebral edema(P<0.05).The receiver operating characteristic curve(ROC)was drawn.The results showed that the area under the curve(AUC)of CBF,MTT,TTP and multi-phase CT angiography for predicting cerebral edema after mechanical thrombectomy in AIS-LVO patients was>0.7,all of which had certain predictive value.The combined predictive AUC was O.963,which had the best predictive value.The sensitivity of combined prediction was 96.20%and the specificity was 88.90%.Conclusion The preoperative CT perfusion imaging and multi-phase CT angiography related parameters of AISLVO mechanical thrombectomy have certain predictive value for the occurrence of postoperative cerebral edema in patients,and their combined predictive performance is the best.