CT平扫对脑动脉血栓形成性急性脑梗死治疗后血管再通的预测效能

Prognostic Efficacy of Plain CT Scan in Vascular Recanalization after Treatment of Acute Cerebral Infarction Caused by Cerebral Artery Thrombosis

目的研究CT平扫对脑动脉血栓形成性急性脑梗死(ACI)治疗后血管再通的预测效能。方法选取2021年1月至2023年12月收治的80例脑动脉血栓形成性ACI进行回顾性研究,根据静脉溶栓后血管再通是否成功分为成功组44例、未成功组36例。比较2组基线资料、CT平扫结果、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及其改善率,分析CT平扫结果对治疗后血管再通的影响及预测效能。结果未成功组发病至溶栓时间长于成功组,无服用抗血小板药物史占比高于成功组(P<0.01);未成功组治疗前和治疗后NIHSS评分高于成功组,NIHSS评分改善率低于成功组(P<0.01);未成功组血栓CT值低于成功组,靶血管等/低密度占比、梗死体积大于成功组(P<0.01)。2组的血栓CT值、靶血管表现、梗死体积均与NIHSS评分改善率呈负相关(P<0.01);Logistic回归分析显示,血栓CT值、靶血管等/低密度、梗死体积是ACI患者治疗后血管再通未成功的独立影响因素(P<0.01)。受试者工作特征曲线分析显示,血栓CT值、靶血管等/低密度、梗死体积联合预测ACI患者治疗后血管再通成功的曲线下面积为0.932,大于三者单独预测(P<0.05),敏感度为86.36%,特异度为86.11%。结论血栓CT值、靶血管等/低密度、梗死体积与脑血栓形成性ACI患者静脉溶栓治疗后血管再通情况有关,CT平扫参数可作为预测血管再通的有效指标,为临床治疗提供决策依据。

Objective To investigate the predictive efficacy of plain CT scan in vascular recanalization after treatment of acute cerebral infarction(ACI)caused by cerebral artery thrombosis.Methods A retrospective study was conducted on 80 patients with ACI caused by cerebral artery thrombosis treated from January 2021 to December 2023.According to the success of vascular recanalization after intravenous thrombolysis,the patients were divided into a successful group(n=44)and an unsuccessful group(n=36).Baseline data,plain CT scan results,National Institutes of Health Stroke Scale(NIHSS)score before and after treatment and improvement rate of the two groups were compared to analyze the influence of plain CT scan results on vascular recanalization after treatment and its predictive efficacy.Results The time from onset to thrombolysis in unsuccessful group was longer than that in successful group,and the proportion of patients who had no history of antiplatelet drug use was higher than that in successful group(P<0.01).The NIHSS score of unsuccessful group was higher than that of successful group before and after treatment,while the improvement rate of NIHSS score was lower than that of successful group(P<0.01).The CT value of thrombus in the unsuccessful group was lower than that in the successful group,while the proportion of target vessels with equal/low density and infarct volume were greater than those in the successful group(P<0.01).The CT value of thrombus,manifestations of target vessels and infarct volume were negatively correlated with the improvement rate of NIHSS score in the two groups(P<0.01).Logistic regression analysis showed that CT value of thrombus,target vessel with equal/low density and infarct volume were independent factors for unsuccessful vascular recanalization in ACI patients after treatment(P<0.01).The analysis of receiver operating characteristic(ROC)curve showed that the area under the ROC curve(AUC)of the combined prediction of CT value of thrombus,target vessel with equal/low density,and infarct volume was 0.932,which was greater than that predicted by the three alone(P<0.05),with the sensitivity of 86.36%and the specificity of 86.11%.Conclusion CT value of thrombus,target vessels with equal/low density,and infarct volume are related to vascular recanalization after intravenous thrombolysis in ACI patients caused by cerebral artery thrombosis.The parameters of plain CT scan can be used as effective indicators to predict vascular recanalization and provide decision-making basis for clinical treatment.