4D CTA-CTP联合血清S100B评估风痰阻络型急性缺血性脑卒中侧支循环及预后的研究

Study on the Level of Collateral Circulation and Prognosis of Acute Ischemic Stroke with 4DCTA-CTP Combined with Serum S100B Technique

目的四维CT血管成像-CT灌注(4DCTACTP)综合技术评价风痰阻络型急性缺血性卒中(AIS)患者的脑侧支循环,探讨以脑侧支循环和血清S100B蛋白浓度预测AIS患者预后的可行性。方法回顾分析32例经4DCTA-CTP治疗的前循环AIS患者的临床资料。通过多期CT血管成像(MCTA)评分和局部软脑膜侧支循环(RLMC)评分评价脑侧支循环水平。结合血清S100B蛋白浓度进行二元Logistic回归分析,寻找可独立预测AIS神经功能预后的指标。结果单因素分析显示NIHSS评分、rLMC评分和MCTA评分与AIS患者的神经预后相关,多因素分析显示MCTA脑侧支循环评分是唯一可以独立预测AIS患者神经预后的指标(OR=0.065,P=0.030)。基线血清S100B蛋白浓度不能独立预测AIS患者的神经预后。结论MCTA脑侧支循环评分可独立预测风痰阻络型AIS患者的神经预后。对于评估AIS患者的神经预后,脑侧支循环时相评分优于局部评分。

Objective To evaluate the lateral cerebral circulation in patients with acute ischemic stroke(AIS)by fourdimensional CT angiography and CT perfusion(4DCTA-CTP),and to explore the feasibility of predicting the prognosis of AIS patients with lateral cerebral circulation and serum S100B protein concentration.Methods The clinical data of 32 patients with anterior circulation AIS treated with 4DCTA-CTP were retrospectively analyzed.Multiphase CT angiography(MCTA)score and local pia collateral circulation(RLMC)score were used to evaluate the level of collateral circulation.Combined with serum S100B protein concentration,multivariate binary Logistic regression analysis was performed to find indicators that could independently predict the prognosis of AIS nerve function.Results Univariate analysis showed that NIHSS score,rLMC score and MCTA score were correlated with the neurological prognosis of AIS patients,and multivariate analysis showed that MCTA collateral circulation score was the only indicator that could independently predict the neurological prognosis of AIS patients(OR=0.065,P=0.030).Baseline serum S100B protein concentration does not independently predict neurological outcomes in AIS patients.Conclusion MCTA collateral circulation score can independently predict the neurological prognosis of AIS patients.For evaluating the neurological prognosis of AIS patients,the temporal score of the lateral cerebral circulation is superior to the local score.