多模式CT检查对急性脑梗死术前侧支循环代偿评估价值及预后影响因素分析

Analysis value and prognostic factors of multi-modal CT examination in assessing collateral circulation compensation before acute cerebral infarction

目的探讨多模式CT检查在评估急性脑梗死病人侧支循环形成方面的价值及其与预后方面的关系。方法选择海安市人民医院2020年1月至2023年12月急性脑梗死病人107例,其中男性69例,女性38例;年龄50~79岁,平均年龄68.4岁;体质量57.8~72.0 kg,平均体质量64.7 kg;高血压71例,糖尿病34例,高血脂52例;饮酒史52例,吸烟史40例。根据侧支循环评估结果分为侧支循环良好组50例,侧支循环不良组57例。所有病人在接受治疗前均行多模式CT检查[CT平扫(NCCT)、CT灌注成像(CTP)及CT血管成像(CTA)]。收集病人临床资料,CTP参数包括脑血容量(CBV)、脑血流量(CBF)、平均通过时长(MTT)和达峰时长(TTP)。采用受试者工作特性(ROC)曲线评估CTP参数评估急性脑梗死病人侧支循环形成方面的价值。多因素Logistic回归分析筛选对急性脑梗死病人预后存在影响的因素。结果侧支循环良好组CBV[(2.54±0.46)mL/100 g]、CBF[(54.77±5.89)mL/(100 g·min)]相较于侧支循环不良组更高[(1.76±0.38)mL/100 g]、CBF[(51.62±4.80)mL/(100 g·min)](P<0.05),而脑梗死病灶体积[(7.33±1.80)mL]则较侧支循环不良组[(17.40±3.41)mL]更小(P<0.05);107例急性脑梗死病人治疗后,78例预后良好,29例预后不良;预后良好组入院时美国国立卫生研究院卒中量表(NIHSS)评分[(9.65±1.78)分]、脑梗死病灶体积[(9.22±2.2)mL]较预后不良组[(12.40±2.41)分、(22.04±4.32)mL]更低,而入院时格拉斯哥昏迷评分(GCS)[(10.78±1.00)分]、CBV[(2.33±0.51)mL/100 g]、CBF[(55.02±6.21)mL/(100 g·min)]较预后不良组[(9.85±0.93)分、(1.57±0.40)mL/100 g、(47.91±5.50)mL/(100 g·min)]更高(P<0.05);CBV、CBF诊断急性脑梗死病人是否建立良好的侧支循环的ROC曲线下面积(AUC)分别为0.914、0.683。Logistic回归结果显示,CBV降低(OR=0.539)、CBF降低(OR=0.553)、脑梗死病灶体积增大(OR=2.168)、年龄增大(OR=1.618)、合并心房颤动(OR=1.811)、入院时NIHSS评分上升(OR=1.721)及GCS下降(OR=0.642)是影响急性脑梗死病人预后的危险因素(P<0.05)。结论多模式CT检查参数中CBV、CBF对急性脑梗死病人侧支循环形成具有较高的评估价值,可作为评估急性脑梗死病人预后的重要指标。

Objective To explore the value of multimodal CT examination for evaluating formation of collateral circulation in patients with acute cerebral infarction and its relationship with prognostic factors.Methods From January 2020 to December 2023,a total of 107 patients with acute cerebral infarction were enrolled,which included 69 males and 38 females,aged 50-79 years old with mean age of 68.4 years old;body mass was 57.8-72.0 kg with mean body mass of 64.7 kg;There were 71 cases of hypertension,34 of diabetes,52 of hyperlipidemia;52 cases of drinking history and 40 of smoking history.According to assessment results of collateral circulation,all of them were divided into good collateral circulation group(n=50)and poor collateral circulation group(n=57).All of them performed multimodal CT examination[CT plain scan(NCCT),CT perfusion imaging(CTP)and CT angiography(CTA)]before treatment.The clinical data and CTP parameters[cerebral blood volume(CBV),cerebral blood flow(CBF),mean transit time(MTT)and time to peak(TTP)]were collected.The receiver operating characteristic(ROC)curve was used to evaluate the value of CTP parameters for evaluating formation of collateral circulation in patients with acute cerebral infarction.The multivariate Logistic regression analysis was used to screen the prognosis related factors in patients with acute cerebral infarction.Results The CBV[(2.54±0.46)mL/100 g]and CBF[(54.77±5.89)mL/(100 g·min)]of good collateral circulation group were significantly higher than those of poor collateral circulation group[CBV(1.76±0.38)mL/100 g],CBF[(51.62±4.80)mL/(100 g·min)](P<0.05),and volume of cerebral infarction in good collateral circulation group[(7.33±1.80)mL]was smaller than that in poor collateral circulation group[(17.40±3.41)mL](P<0.05).After treatment,there were 78 cases showed good prognosis and 29 showed poor.In good prognosis group,the National Institutes of Health Stroke Scale(NIHSS)score at admission[(9.65±1.78)scores],volume of cerebral infarction[(9.22±2.2)mL]were remarkably lower than those in poor prognosis group[(12.40±2.41)scores,(22.04±4.32)mL];Glasgow coma score(GCS)[(10.78±1.00)scores],CBV[(2.33±0.51)mL/100 g],CBF[(55.02±6.21) L/(100 g·min)]at admission of good collateral circulation group were significantly higher than those of poor prognosis group[(9.85±0.93)scores,(1.57±0.40)mL/100 g,(47.91±5.50)mL/(100 g·min)](P<0.05).The area under ROC curve(AUC)of CBV and CBF were 0.914 and 0.683,respectively,in diagnosing the establishment of good collateral circulation in patients with acute cerebral infarction.Logistic regression results showed that decreased CBV(OR=0.539),decreased CBF(OR=0.553),increased cerebral infarction lesion volume(OR=2.168),increased age(OR=1.618),combined atrial fibrillation(OR=1.811),increased NIHSS score at admission(OR=1.721)and decreased GCS(OR=0.642)were risk factors in the prognosis of patients with acute cerebral infarction(P<0.05).Conclusion It is demonstrated that among multimode CT examination parameters,CBV and CBF showed high evaluation value for formation of collateral circulation in patients with acute cerebral infarction,which could be used as an important index to evaluate prognosis of patients with acute cerebral infarction.