双源CT颅脑灌注成像联合血清UCH-L1、Lp-pLA2在急性脑梗死患者诊断和预后不良预测中的应用价值

Application Value of Dual-Source CT Cerebral Perfusion Imaging Combined with Serum UCH-L1 and Lp-pLA2 in the Diagnosis and Poor Prognosis Prediction of Patients with Acute Cerebral Infarction

目的:探讨双源CT颅脑灌注成像联合血清泛素羧基末端水解酶L1(UCH-L1)、脂蛋白相关磷酯酶A2(Lp-pLA2)在急性脑梗死(ACI)患者诊断和预后不良预测中的应用价值。方法:选择2021年2月至2023年3月呼伦贝尔市人民医院收治的151例ACI患者作为ACI组和109例健康志愿者作为对照组。根据美国国立卫生研究院卒中量表(NIHSS)将ACI患者分为轻度组(52例)、中度组(53例)和重度组(46例);根据改良Rankin评分量表(m RS)将ACI患者分为预后不良组(37例)、预后良好组(114例)。所有受试者均接受双源CT颅脑灌注成像检查获得相关参数脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP),并检测血清UCH-L1、Lp-pLA2水平。受试者工作特征(ROC)曲线分析双源CT颅脑灌注成像参数联合血清UCH-L1、Lp-pLA2诊断ACI以及预测ACI患者预后的价值。结果:ACI组CBF、CBV低于对照组(P<0.05),MTT、TTP长于对照组(P<0.05),血清UCH-L1、Lp-pLA2水平高于对照组(P<0.05)。重度组CBF、CBV低于中度组和轻度组(P<0.05),MTT、TTP长于中度组和轻度组(P<0.05),血清UCH-L1、Lp-pLA2水平高于中度组和轻度组(P<0.05)。中度组CBF、CBV低于轻度组(P<0.05),MTT、TTP长于轻度组(P<0.05),血清UCH-L1、Lp-pLA2水平高于轻度组(P<0.05)。预后不良组CBF、CBV低于预后良好组(P<0.05),MTT、TTP长于预后良好组(P<0.05),血清UCH-L1、Lp-pLA2水平高于预后良好组(P<0.05)。ROC曲线分析显示:联合双源CT颅脑灌注成像参数和血清UCH-L1、Lp-pLA2诊断ACI、预测ACI预后不良的曲线下面积分别为0.898、0.892均高于单独指标诊断和预测。结论:ACI患者双源CT颅脑灌注成像参数CBF、CBV降低,MTT、TTP延长,血清UCH-L1和Lp-p LA2水平增高,且与ACI神经缺损加重以及预后不良有关。联合双源CT颅脑灌注成像参数和血清UCH-L1和Lp-pLA2在ACI诊断和预后分析中均有较高的价值。

Objective:To investigate the application value of dual-source CT cerebral perfusion imaging combined with serum ubiquitin carboxyl-terminal hydrolase L1(UCH-L1)and lipoprotein-associated phospholipase A2(Lp-pLA2)in the diagnosis and poor prognosis prediction of patients with acute cerebral infarction(ACI).Methods:151 ACI patients admitted to Hulunbuir People's Hospital from February 2021 to March 2023 were selected as ACI group and 109 healthy volunteers as control group.According to the National Institutes of Health Stroke Scale(NIHSS),ACI patients were divided into mild group(52 cases),moderate group(53 cases),severe group(46 cases);and according to the Modified Rankin Score Scale(mRS),ACI patients were divided into poor prognosis group(37 cases)and good prognosis group(114 cases).All subjects were underwent dual-source CT cerebral perfusion imaging to obtain relevant parameters of cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and time to peak(TTP),and serum UCH-L1 and Lp-pLA2 levels were detected.The value of dual-source CT cerebral perfusion imaging parameters combine with serum UCH-L1 and Lp-pLA2 in the diagnosis of ACI and predicted the prognosis of ACI patients were analyzed by receiver operating characteristic(ROC)curve.Results:CBF and CBV in ACI group were lower than those in control group(P<0.05),MTT and TTP in ACI group were longer than those in control group(P<0.05),serum UCH-L1 and Lp-pLA2 levels in ACI group were higher than those in control group(P<0.05).CBF and CBV in severe group were lower than those in moderate group and mild group(P<0.05),MTT and TTP in severe group were longer than those in moderate group and mild group(P<0.05),and serum UCH-L1 and Lp-pLA2 levels in severe group were higher than those in moderate group and mild group(P<0.05).CBF and CBV in moderate group were lower than those in mild group(P<0.05),MTT and TTP in moderate group were longer than those in mild group(P<0.05),and serum UCH-L1 and Lp-pLA2 levels in moderate group were higher than those in mild group(P<0.05).CBF and CBV in poor prognosis group were lower than those in good prognosis group(P<0.05),MTT and TTP in poor prognosis group were longer than those in good prognosis group(P<0.05),and serum UCH-L1 and Lp-pLA2 levels in poor prognosis group were higher than those in good prognosis group(P<0.05).ROC curve analysis showed that:the area under the curve of combine dual-source CT cerebral perfusion imaging parameters and serum UCH-L1 and Lp-pLA2 in the diagnosis of ACI and the prediction of poor prognosis of ACI were 0.898 and 0.892,respectively,which were higher than those of single index diagnosis and prediction.Conclusion:In ACI patients,dual-source CT cerebral perfusion imaging parameters CBF and CBV decrease,MTT and TTP prolonged,serum UCH-L1 and Lp-pLA2 levels increase,which are relate to the aggravation of ACI nerve defect and poor prognosis.The combination of dual-source CT cerebral perfusion imaging parameters and serum UCH-L1 and Lp-pLA2 has high value in the diagnosis and prognosis analysis of ACI.