脑内深部静脉与急性缺血性卒中静脉溶栓后远期预后的相关性研究

发布时间：2018-01-15 04:19

  本文关键词：脑内深部静脉与急性缺血性卒中静脉溶栓后远期预后的相关性研究　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 磁敏感成像 急性缺血性脑卒中 静脉溶栓治疗 丘纹静脉

【摘要】：背景与目的脑内深部静脉对急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后神经功能结局的影响目前尚不明确。本研究旨在观察AIS磁敏感影像(Susceptibility-weighted imaging,SWI)上的静脉表现,并探讨其与静脉溶栓后远期功能结局的关系。材料与方法我们回顾2011年9月至2015年7月期间发病6小时内在浙江大学附属第二医院神经内科接受静脉阿替普酶(recombinant tissue plasminogen activator,rt-PA)溶栓治疗的AIS且溶栓前行多模式磁共振检查的患者。利用SWI重建影像评估静脉,测定双侧丘纹静脉(thalamostriate vein,TSV),隔静脉(septal vein,SV),大脑内静脉(internal cerebral vein,ICV)的信号密度值,计算双侧静脉的相对信号差率(signal difference ratio,SDR)。溶栓后24小时灌注恢复≥70%定义为成功再灌。3 月改良 Rankin 评分(3 month-modified Rankin Scale,3m-mRS)2 分定义为预后不良,分析TSV,SV,ICV的SDR与静脉溶栓后远期预后的关系。研究结果共109例患者纳入分析,只有TSV的SDR与静脉溶栓后远期预后不良(3m-mRS2)(ρ= 0.25,p = 0.008)显着相关,其预测预后不良的最佳阈值为SDR4.8%(敏感性为 53.7%,特异性为 80.9%)。而 SV(ρ=0.04,p = 0.73)或 ICV(ρ=0.07,p = 0.47)的SDR与预后无相关性。我们定义TSV的SDR≥5%为"患侧丘纹静脉明显(ipsilateral prominent TSV,IPTSV)"。共 35 例(32.1%)存在 IPTSV。与无IPTSV征象的患者相比,具有IPTSV征象的患者获得成功再灌的比例更低(37.5%vs 60.0%,OR = 0.35,95%CI 0.13-0.92,p = 0.03),且更可能远期预后不良(62.9%vs 25.7%,OR = 3.66,95%CI 1.25-10.68,p = 0.02)。在具有 IPTSV 征象的患者中,未达到成功再灌者更易远期预后不良(80.0%vs44.4%,p = 0.04)。研究结论基线IPTSV征象提示静脉溶栓后成功再灌率较低,且具有该征象的患者更易远期预后不良。对于此类患者,可能需要进一步的再灌注治疗。
[Abstract]:Background & objective to treat acute ischemic stroke in acute ischemic stroke with deep cerebral vein. The effect of neurologic outcome after intravenous thrombolytic therapy in patients with AIS was not clear. The purpose of this study was to observe the magnetic sensitivity imaging of AIS (. Susceptibility-weighted imaging. The venous manifestations on SWI. Materials and methods We reviewed the clinical efficacy of intravenous thrombolytic therapy in the Department of Neurology of the second affiliated Hospital of Zhejiang University within 6 hours of onset from September 2011 to July 2015. Matipase (. Recombinant tissue plasminogen activator. Patients with AIS treated with rt-PA and multimode MRI before thrombolytic therapy. Vein was evaluated by SWI reconstruction imaging. The bilateral papular vein thalamostriate TSVV and septal vein in SVS were measured. The signal density of internal cerebral vein (cerebral). The relative signal difference ratio was calculated. 24 hours after thrombolytic thrombolysis 鈮，

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