FLAIR血管高信号对急性前循环梗死患者侧支循环评价以及短期预后的评估

发布时间：2018-02-27 14:31

本文关键词： FLAIR高信号血管征大脑中动脉闭塞侧支循环预后　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究以大脑中动脉(middle cerebral artery,MCA)M1段急性闭塞的患者为研究对象,探讨FLAIR血管高信号(FLAIR vascular hyperintensity,FVH)评价侧支循环的准确性;研究影响FVH的相关因素;评估FVH能否作为判断临床病情严重程度及短期预后的指标。对象与方法:我们回顾性分析了从2011年1月——2016年12月期间于大连医科大学附属第二医院神经内科住院的大脑中动脉M1段急性闭塞的患者,最后有53名患者被纳入分析,其中男性29例,女性24例,平均年龄60.03岁(30-84岁)。入院24小时内磁共振检查明确脑梗死诊断,入院72小时内完成全脑血管造影检查明确其责任病变为大脑中动脉M1段闭塞。用阿尔伯塔脑卒中计划早期诊断评分(Alberta Stroke Program Early CT Score,ASPECT)评估FLAIR成像上的FVH,用美国介入和治疗神经放射学学会、介入放射学学会侧支循环评分(American Society of Interventional and Therapeutic Neuroradiology、Society of Interventional Radiology ASITN/SIR)来评估侧支循环。依据FVH-ASPECT评分对FVH进行评价并分为低表达(0-4分)、中表达(5-8分)以及高表达(9-12分)三组,比较各组间的临床资料。采用ASITN/SIR评分对大脑中动脉梗死区域内的侧支循环进行评估。将数据分为两组,代偿充分组(3-4)和代偿不充分组(0-2)。同样比较各组间的临床资料。用等级回归对FVH的影响因素进行分析。用ROC曲线分析FVH对侧支循环的诊断价值。用Mann-Whitney U检验对两组的初始NIHSS评分和7天NIHSS评分进行分析。结果:总共纳入符合标准的患者53例,其中远端FVH阳性46例(87%),男性26例(57%),女性20例(43%)。FVH与吸烟、冠心病、糖尿病及入院时的血压相关。侧支循环与吸烟及血压相关。FVH危险因素的多因素回归分析显示,在排除其它因素的情况下,吸烟、冠心病对FVH有显著影响,吸烟患者的FVH分级更高,合并冠心病的患者FVH分级更低。ROC曲线下面积为0.893(95%CI:0.808-0.977),说明FVH对侧支循环的诊断价值较高。当FVH为7.5时,对侧支循环的诊断价值最高,灵敏度为0.694,特异度为0.938。FVH各组的初始NIHSS和7天NIHSS差异均有统计学意义(P0.05),FVH分类的级别越高,初始NIHSS评分和7天NIHSS评分越低。结论:(1)本研究结果显示对于大脑中动脉M1段闭塞的患者,FVH阳性率为87%(46/53),且与软脑膜侧支循环显著相关,对侧支循环的诊断率达到96%(46/48)。(2)入院时的收缩压及舒张压与侧支循环以及FVH相关。(3)FVH-ASPECT评分能够准确评估侧支循环(ROC曲线下面积为0.893,95%CI:0.808-0.977),灵敏度为0.694,特异度为0.938。建议临床上可用FVH代替磁共振灌注成像来作为急性期侧支循环的评估。(4)FVH-ASPECT评分与脑梗死患者临床预后相关,FVH-ASPECT评分高的患者,初始及7天后的NIHSS评分均低于评分较低的。
[Abstract]:Objective: to investigate the accuracy of evaluation of collateral circulation in patients with acute occlusion of middle middle cerebral artery of middle cerebral artery (MCA-MCA-M1) with high signal FLAIR vascular hyperintensity, and to study the related factors affecting FVH. Objective and methods: from January 2011 to December 2016, we retrospectively analyzed the hospitalization in the Department of Neurology, second affiliated Hospital, Dalian Medical University, from January 2011 to December 2016. In patients with acute occlusion of M1 segment of the middle cerebral artery, Finally, 53 patients were included in the analysis, including 29 males and 24 females, with an average age of 60.03 years or 30-84 years. MRI was used to diagnose cerebral infarction within 24 hours of admission. Complete all cerebral angiography within 72 hours of admission to determine whether the responsible lesion is M1 segment occlusion of the middle cerebral artery. The Alberta Stroke Program Early CT ScoreASPECT was used to evaluate the FVHs on FLAIR imaging. Society of Therapeutic Neuroradiology, American Society of Interventional and Therapeutic collateral circulation was evaluated by American Society of Interventional Radiology ASITN / SIRs. FVH was evaluated according to FVH-ASPECT score and divided into three groups: low expression 0-4, middle expression 5-8) and high expression 9-12). ASITN/SIR score was used to evaluate the collateral circulation in the infarcted area of the middle cerebral artery. The data were divided into two groups. The clinical data of each group were also compared. The influencing factors of FVH were analyzed by grade regression. The diagnostic value of contralateral collateral circulation of FVH was analyzed by ROC curve. The diagnostic value of Mann-Whitney U test was used for the two groups. The initial NIHSS score and 7 day NIHSS score were analyzed. Results: a total of 53 eligible patients were included. 46 cases of distal FVH were positive, 26 cases were male, 20 cases were female, 20 cases were associated with smoking, coronary heart disease, diabetes mellitus and blood pressure on admission. The multiple regression analysis of collateral circulation and risk factors of smoking and blood pressure. When other factors were excluded, smoking and coronary heart disease had significant effects on FVH. The FVH grade of smoking patients was higher than that of controls. In patients with coronary heart disease, the area under the curve of lower .ROC was 0.89395% CI: 0.808-0.977, which indicated that the diagnostic value of contralateral collateral circulation of FVH was higher when FVH was 7.5.The diagnostic value of contralateral collateral circulation was the highest when FVH was 7.5. The sensitivity was 0.694, the specificity was 0.938. The difference of initial NIHSS and 7-day NIHSS was statistically significant. Conclusion the results of this study showed that the positive rate of NIHSS in patients with M1 segment occlusion of middle cerebral artery was 8746 / 53, and was significantly correlated with collateral circulation of pia. The diagnostic rate of contralateral collateral circulation was 96 / 46 / 48. 2) systolic and diastolic blood pressure and collateral circulation and FVH related FVH-ASPECT score could accurately evaluate the area under the ROC curve of collateral circulation was 0.808-0.9777.The sensitivity was 0.694, and the specificity was 0.938. Using FVH instead of magnetic resonance perfusion imaging as an assessment of collateral circulation in acute phase, the FVH-ASPECT score was correlated with the clinical prognosis of patients with cerebral infarction and the patients with high FVH-ASPECT score. NIHSS scores were lower at the beginning and 7 days later than those with lower scores.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

【参考文献】