动脉瘤性蛛网膜下腔出血患者脑CTP特征及其与不良预后的相关性

Characteristics of cortical CTP in patients with aneurysmal subarachnoid hemorrhage and its correlation with poor prognosis

目的探讨动脉瘤性蛛网膜下腔出血(Aneurysmal subarachnoid hemorrhage,aSAH)患者脑计算机X线断层扫描灌注成像(Computed tomography perfusion imaging,CTP)特征及其与不良预后的相关性。方法纳入2021年1月-2023年12月本院163例aSAH患者为研究对象,所有患者均在入院时接受脑CTP检查,获取患者CTP特征及衍生图像;后随访3个月记录患者预后情况,并根据患者预后情况分为预后良好组和预后不良组,比较2组患者脑CTP特征差异;利用Logistic回归分析aSAH患者脑CTP特征与预后的关系;绘制受试者工作特征曲线(Receiver operator characteristic curve,ROC)获取CTP特征的临界值。结果多因素Logistic回归显示,年龄、糖尿病、收缩压、舒张压、平均动脉压、迟发性脑缺血、脑血流量(Cerebral blood flow,CBF)、脑血容量(Cerebral blood volume,CBV)水平、平均通过时间(Mean transit time,MTT)、脑血管痉挛是aSAH患者预后不良的影响因素(P<0.05);去除混杂因素(年龄、糖尿病、收缩压、舒张压、平均动脉压、迟发性脑缺血、脑血管痉挛)后CBF,CBV水平、MTT仍是aSAH患者预后不良的影响因素(P<0.05);ROC分析显示,CBF,CBV水平、MTT的敏感度分别为75.86、79.31、77.59%,特异度分别为62.86、60.14、59.33%,临界值分别为33.50 mL·100 g^(-1)·min^(-1)、1.65 mL/100 g、4.00 s。结论aSAH患者CBF,CBV,MTT水平与患者不良预后显著相关。

Objective To investigate the characteristics of cortical cerebral perfusion imaging(CTP)in patients with aneurysmal subarachnoid hemorrhage(aSAH)and its correlation with poor prognosis.Methods 163 patients with aSAH who received treatment from January 2021to December 2023 in our hospital were included as the research objects.All patients underwent cerebral perfusion imaging(CTP)on admission,and their CTP characteristics and derived images were obtained.During the 3 months'follow-up,the patients'prognosis was recorded,and they were divided into two groups according to their prognosis.The differences of cerebral cortex CTP characteristics between the two groups were compared.Logistic regression was used to analyze the relationship between cerebral cortex CTP characteristics and prognosis of aSAH patients,and the critical value of CTP characteristics was obtained by receiver operating characteristic curve(ROC).Results Multivariate logistic regression showed that age,diabetes,systolic blood pressure,diastolic blood pressure,mean arterial pressure,delayed cerebral ischemia,CBF,CBV,MTT levels and cerebral vasospasm were the influencing factors for the poor prognosis of aSAH patients(P<0.05),as shown in Table 2.After removing the confounding factors(age,diabetes,systolic blood pressure,diastolic blood pressure,mean arterial pressure,delayed cerebral ischemia and cerebral vasospasm),the levels of CBF,CBV and MTT were still the influencing factors for the poor prognosis of aSAH patients(P<0.05).ROC curve analysis shows that the sensitivity of CBF,CBV and MTT are 75.86%,79.31%and 77.59%,the specificity is 62.86%,60.14%and 59.33%respectively,and the critical values are 33.50 mL/100 g/min,1.65 mL/100 g and 4.00 s respectively.Conclusion The levels of CBF,CBV and MTT in aSAH patients were significantly related to the poor prognosis.