磁共振弥散张量成像参数与急性脑梗死患者脑水肿的相关性分析

Correlations between diffusion tensor imaging parameters and brain edema in patients with acute cerebral infarction

目的探讨急性脑梗死(ACI)患者磁共振弥散张量成像(DTI)参数、血清小而密低密度脂蛋白胆固醇(sd LDL-C)、bcl-2同源结构域蛋白(Beclin-1)水平与神经功能缺损程度、脑水肿严重程度的相关性。方法回顾性选取2023年1月至2024年1月商丘市中医院收治的105例ACI患者作为观察组[男62例、女43例,年龄(63.29±3.28岁)],同期健康志愿者35例作为对照组[男20例、女15例,年龄(64.11±3.02岁)],比较两组DTI参数[各向异性指数(FA)、平均弥散系数(DCavg)]与血清sd LDL-C、Beclin-1水平。观察组患者依据美国国立卫生研究院卒中量表(NIHSS)分为轻度损伤39例、中度损伤34例、重度损伤32例,依据脑水肿严重程度分为轻度68例、重度37例,比较其DTI参数、血清sd LDL-C与Beclin-1水平。组间比较采用独立样本t检验,多组间比较采用单因素方差分析,计数资料采用χ^(2)检验,Spearman相关分析其与神经功能缺损程度、脑水肿严重程度的相关性。受试者工作特征曲线(ROC)分析DTI参数、血清sd LDL-C与Beclin-1对脑水肿严重程度的评估价值。结果观察组FA、DCavg分别为(0.19±0.04)、(5.03±1.07),低于对照组[(0.35±0.06)、(8.62±1.28)],血清sd LDL-C、Beclin-1水平分别为(1.24±0.31)mmol/L、(3.29±0.85)μg/L,高于对照组[(0.45±0.11)mmol/L、(1.09±0.29)μg/L],差异均有统计学意义(均P<0.05);随着神经功能缺损程度加重,FA、DCavg呈下降趋势,血清sd LDL-C、Beclin-1水平呈上升趋势(均P<0.05);重度脑水肿的FA、DCavg低于轻度者,血清sd LDL-C、Beclin-1水平高于轻度者(均P<0.05);FA、DCavg与神经功能缺损程度、脑水肿严重程度呈负相关(rFA=-0.528、-0.627,r_(DCavg)=-0.559、-0.603,均P<0.05),而血清sd LDL-C、Beclin-1与神经功能缺损程度、脑水肿严重程度呈正相关(r_(sd LDL-C)=0.485、0.501,r_(Beclin-1)=0.449、0.621,均P<0.05);FA、DCavg与血清sd LDL-C、Beclin-1单项及联合评估脑水肿严重程度的AUC分别为0.740、0.763、0.788、0.811、0.908,联合评估的AUC优于单项指标(P<0.05)。结论ACI患者FA、DCavg降低,血清sd LDL-C、Beclin-1水平升高,且与神经功能缺损程度、脑水肿严重程度密切相关,联合检测对脑水肿程度具有一定评估价值。

Objective To explore the correlations of magnetic resonance diffusion tensor imaging(DTI)parameters,serum small and dense low-density lipoprotein cholesterol(sd LDL-C),and the level of homologous domain protein(Beclin-1)of bcl-2 with the degree of neurological deficits and the severity of cerebral edema in patients with acute cerebral infarction(ACI).Methods One hundred and five patients with ACI treated at Shangqiu Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected as an observation group,including 62 males and 43 females who were(63.29±3.28)years old.Thirty-five healthy volunteers during the same period were selected as a control group,including 20 males and 15 females who were(64.11±3.02)years old.The DTI parameters[anisotropy index(FA)and mean diffusion coefficient(DCavg)]and serum levels of sd LDL-C and Beclin-1 were compared between the two groups.According to the scores of National Institutes of Health Stroke Scale(NIHSS),the observation group were divided into mild injury(39 cases),moderate injury(34 cases),and severe injury(32 cases);according to the severity of brain edema,they were divided into mild(68 cases)and severe(37 cases).The DTI parameters and serum levels of sdLDL-C and Beclin-1 were compared.The data were compared between the two groups by the independent-sample t test and between 3 or more than 3 groups by one-way analysis of variance.The count data were compared byχ^(2)test.The Spearman correlation analysis was used to investigate their correlations with the degree of neurological deficit and severity of brain edema.The receiver operating characteristic curve(ROC)was used to evaluate the value of DTI parameters,sd LDL-C,and Beclin-1 in assessing the severity of brain edema.Results The FA and DCavg in the observation group were lower than those in the control group[(0.19±0.04)vs.(0.35±0.06)and(5.03±1.07)vs.(8.62±1.28)];the serum levels of sd LDL-C and Beclin-1 in the observation group were higher than those in the control group[(1.24±0.31)mmol/L vs.(0.45±0.11)mmol/L and(3.29±0.85)μg/L vs.(1.09±0.29)μg/L];there were statistical differences(all P<0.05).As the degree of neurological deficit increased,FA and DCavg showed a downward trend,while the serum levels of sd LDL-C and Beclin-1 showed an upward trend(all P<0.05).The FA and DCavg in the patients with severe brain edema were lower than those in the patients with mild brain edema(both P<0.05);the serum levels of sd LDL-C and Beclin-1 in the patients with severe brain edema were higher than those in the patients with mild brain edema(both P<0.05).FA and DCavg were negatively correlated with the degree of neurological deficit and severity of brain edema(rFA=-0.528 and-0.627;r_(DCavg)=-0.559 and-0.603;all P<0.05);the serum levels of sd LDL-C and Beclin-1 were positively correlated with the degree of neurological deficit and severity of brain edema(r_(sd LDL-C)=0.485 and 0.501;r_(Beclin-1)=0.449 and 0.621;all P<0.05).The areas under the curves(AUC)of FA,DCavg,sd LDL-C,Beclin-1,and their combination for evaluating the severity of brain edema were 0.740,0.763,0.788,0.811,and 0.908,respectively;and the combination's AUC was superior to those of the individual indicators(P<0.05).Conclusions In patients with ACI,FA and DCavg decrease,while the serum levels of sd LDL-C and Beclin-1 increase;they are closely related to the degree of neurological deficits and the severity of brain edema.Combined detection of their levels has certain evaluation value for the degree of brain edema.