磁共振血管成像结合CT血管造影对老年脑梗死患者神经功能预后的预测价值分析

Predictive value of MRA combined with CTA for neurological function in elderly patients with cerebral infarction

目的探讨磁共振血管成像(magnetic resonance angiography,MRA)结合CT血管造影(CT angiography,CTA)对老年脑梗死患者神经功能预后的预测价值及其影响因素。方法选取2020年4月至2023年8月淮安市第二人民医院神经内科收治的老年脑梗死患者102例,根据改良的Rankin量表(modified Rankin scale,mRS),将患者分为预后良好组66例(mRS评分≤3分)和预后不良组36例(mRS评分>3分)。收集患者的临床资料,采用MRA检查病变部位狭窄率,根据CTA检查进行Alberta卒中项目早期CT评分(Alberta stroke program early CT score,ASPECTS)半定量评估,采用多因素logistic回归分析神经功能预后不良的影响因素,并通过绘制ROC曲线来评估MRA结合CTA在预测中的价值。结果预后不良组年龄、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、白细胞计数、中性粒细胞计数、同型半胱氨酸明显高于预后良好组(P<0.01)。预后不良组狭窄率明显高于预后良好组,ASPECTS明显低于预后良好组(P<0.01)。多因素logistic回归分析显示,NIHSS评分、白细胞计数、中性粒细胞计数、狭窄率、ASPECTS是影响老年脑梗死患者神经功能预后不良的独立危险因素(P<0.05,P<0.01)。狭窄率、ASPECTS及两者联合预测老年脑梗死患者神经功能预后不良的曲线下面积(areas under curve,AUC)分别为0.745(95%CI:0.645~0.844)、0.711(95%CI:0.598~0.824),两者联合预测的AUC较高,为0.891,敏感性为87.76%,特异性为63.65%。结论NIHSS评分、白细胞计数、中性粒细胞计数、狭窄率、ASPECTS是影响老年脑梗死患者神经功能预后不良的独立危险因素,而将基于MRA、CTA得出的狭窄率、ASPECTS两者联合具有较高的预测价值。

Objective To analyze the predictive value of magnetic resonance angiography(MRA)combined with CT angiography for the prognosis of neurological function in elderly patients with cerebral infarction and its influencing factors.Methods A total of 102 elderly patients with cerebral infarction admitted to our hospital from April 2020 to August 2023 were recruited,and according to the modified Rankin scale(mRS),they were divided into good prognosis group(mRS score≤3,66 patients)and poor prognosis group(mRS score>3,36 patients).Their clinical data were collected.The stenosis rate of the lesion site was examined by MRA,and the Alberta stroke program early CT score(ASPECTS)was semi-quantitatively evaluated with CT angiography examination.Multivariate logistic regression analysis was used to identify the influencing factors for poor neurological prognosis.ROC curve was plotted to analyze the predictive value of MRA combined with CT angiography for the prognosis.Results Advanced age,higher NIHSS score,larger white blood cell and neutrophil counts,and higher homocysteine level were observed in the poor prognosis group than the good prognosis group(P<0.01).The poor prognosis group had significantly higher stenosis rate and lower ASPECTS than the good prognosis group(P<0.01).Multivariate logistic regression analysis showed that NIHSS score,white blood cell count,neutrophil count,stenosis rate and ASPECTS were independent risk factors for poor prognosis of neurological function in elderly patients with cerebral infarction(P<0.05,P<0.01).The AUC value of stenosis rate,ASPECTS and their combination in predicting poor prognosis of neurological function in elderly patients with cerebral infarction were 0.745(95%CI:0.645-0.844)and 0.711(95%CI:0.598-0.824),and 0.891,respectively.The AUC value of the combination was the highest,with a sensitivity of 87.76%and a specificity of 63.65%.Conclusion NIHSS score,white blood cell count,neutrophil count,stenosis rate and ASPECTS are independent risk factors for poor prognosis of neurological function in elderly patients with cerebral infarction.The combination of stenosis rate and ASPECTS based on MRA and CT angiography has the highest predictive value.