颅脑MRI对老年多发性脑梗死溶栓术后预后不良的预测探讨

Exploration of prediction of poor prognosis after thrombolysis among elderly patients with multiple cerebral infarction by cranial MRI

目的探讨颅脑磁共振成像(MRI)对老年多发性脑梗死(MCI)溶栓术后预后不良的预测价值。方法选择2022年3月—2023年9月本院收治的168例老年MCI患者作为研究对象,均采用溶栓术治疗,并于术前行颅脑MRI检查。随访3个月后评估预后,并将MCI患者分为A组(预后不良)和B组(预后良好),比较两组颅脑MRI参数。采用多因素Logistic回归分析老年MCI溶栓术后预后不良的影响因素;绘制受试者工作特征(ROC)曲线评估颅脑MRI对老年MCI溶栓术后预后不良的预测价值。结果老年MCI患者中预后不良发生率为35.12%(59/168)。A组达峰时间(TTP)、平均通过时间(MTT)、入院时美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间、C-反应蛋白(CRP)水平均高于B组(P<0.05),而表观弥散系数(ADC)值、脑血容积(CBV)、脑血流量(CBF)均低于B组(P<0.05);多因素Logistic回归分析显示TTP、MTT、入院时NIHSS评分、发病至溶栓时间、CRP水平均是老年MCI溶栓术后预后不良的危险因素(P<0.05),ADC、CBV、CBF是其保护因素(P<0.05);ROC曲线分析显示,ADC、CBV、CBF、TTP、MTT联合预测老年MCI溶栓术后预后不良的灵敏度和曲线下面积分别为94.92%、0.916,均高于各指标单独预测(P<0.05),其特异度与各指标单独预测基本一致。结论颅脑MRI参数ADC、TTP、MTT、CBV、CBF均可预测老年MCI溶栓术后预后情况,但各参数联合能够进一步提高预测价值。

Objective To explore the predictive value of cranial magnetic resonance imaging(MRI)for poor prognosis after thrombolysis in elderly patients with multiple cerebral infarction(MCI).Methods A total of 168 elderly MCI patients admitted from March 2022 to September 2023 were selected as study subjects.All patients were treated with thrombolysis and underwent preoperative cranial MRI.After a 3-month follow-up,prognosis was evaluated,and patients were divided into Group A(poor prognosis)and Group B(good prognosis).Cranial MRI parameters of the two groups were compared.Logistic regression analysis was used to analyze the factors influencing poor prognosis after thrombolysis in elderly MCI patients,and the predictive value of cranial MRI for poor prognosis was assessed using the receiver operating characteristic(ROC)curve.Results The incidence rate of poor prognosis in elderly patients with MCI was 35.12%(59/168).The time to peak(TTP),mean transit time(MTT),National Institutes of Health Stroke Scale(NIHSS)score at admission,onset to thrombolysis time and C-reactive protein(CRP)level in Group A were higher than those in Group B(P<0.05),while the value of apparent diffusion coefficient(ADC),cerebral blood volume(CBV)and cerebral blood flow(CBF)were lower than those in Group B(P<0.05).Multivariate logistic regression analysis showed that TTP,MTT,NIHSS score at admission,time from onset to thrombolysis and CRP level were all risk factors for poor prognosis after thrombolysis in elderly patients with MCI(P<0.05),while ADC,CBV and CBF were protective factors(P<0.05).ROC curve analysis showed that the sensitivity and area under curve of combined prediction of ADC,CBV,CBF,TTP,and MTT for poor prognosis after thrombolysis in elderly patients with MCI were 94.92%and 0.916 respectively,which were higher than those predicted by each indicator alone(P<0.05),however,the specificity was consistent with the predictive basis of each indicator alone.Conclusions Cranial MRI parameters including ADC,TTP,MTT,CBV,and CBF can predict the prognosis of elderly MCI patients after thrombolysis,and their combination can further improve the predictive value.