DWI-ASPECTS和MRA-CBS对急性脑梗死溶栓治疗后出血转化预测价值的研究

发布时间：2019-01-09 05:59

【摘要】：目的：研究DWI-ASPECTS和MRA-CBS对急性前循环脑梗死患者溶栓治疗后发生出血转化(HT, Hemorrhagic transformation)的预测价值。方法：回顾性分析37例急性前循环脑梗死患者溶栓治疗前的临床资料和溶栓治疗前后的MRI图像。依据溶栓治疗后24小时内的ESWAN图像,将患者分为HT和无HT两组,比较两组患者入院时的临床资料、DWI图像上的ASPECTS分值、MRA图像上的CBS分值以及DWI病灶体积是否存在差异,并进一步分析不同指标对溶栓治疗后HT发生的独立预测价值。结果： ①发生HT的患者与未发生HT的患者相比,入院时的NIHSS分值更高(均值,15vs.7, p=0.00020), DWI-ASPECTS分值更低(中值,6vs.9,p=0.00004),MRA-CBS分值更低(中值,7vs.10,p=0.04587),DWI高信号区范围更大(中值,14vs.0,p=0.00037)。②入院时的DWI-ASPECTS分值(OR0.424,95%CI0.206-0.872, p=0.020)和NIHSS分值(OR1.219,95%CI1.003-1.481,p=0.046)是急性脑梗死患者溶栓治疗后发生HT的独立预测因素。③DWI-ASPECTS分值预测溶栓治疗后24小时内发生HT的最佳分割点为=7(敏感性为92.9%,特异性为78.3%,曲线下面积为0.902,p=0.00005) 结论： DWI-ASPECTS对急性脑梗死患者溶栓治疗后HT的发生有重要的预测价值。MRA-CBS能够为预测HT发生提供补充信息。
[Abstract]:Objective: to study the predictive value of DWI-ASPECTS and MRA-CBS in patients with acute anterior circulation cerebral infarction (ACI). Methods: the clinical data and MRI images of 37 patients with acute anterior circulation cerebral infarction before and after thrombolytic therapy were analyzed retrospectively. According to the ESWAN images within 24 hours after thrombolytic therapy, the patients were divided into two groups: HT group and no HT group. The clinical data, ASPECTS score on DWI image, CBS score on MRA image and the volume of DWI lesion were compared between the two groups. The independent predictive value of different indexes for HT after thrombolytic therapy was analyzed. Results: 1patients with HT had higher NIHSS scores at admission than those without HT (mean, 15vs.7, p0. 00020), lower DWI-ASPECTS scores (median, 6vs.9p0. 004), and lower MRA-CBS scores (median). 7vs.10s. 10PU 0.04587), DWI high signal range (median, 14vs.0. 0p0. 00037). 2admission DWI-ASPECTS score (OR0.424,95%CI0.206-0.872, p0. 020) and NIHSS score (OR1.219,95%CI1.003-1.481,). 3DWI-ASPECTS score was an independent predictor of HT in patients with acute cerebral infarction after thrombolytic therapy. The best partition point for predicting the occurrence of HT within 24 hours after thrombolytic therapy was = 7 (sensitivity 92.9%, specificity 78.3%). Conclusion: DWI-ASPECTS plays an important role in predicting the occurrence of HT in patients with acute cerebral infarction after thrombolytic therapy. MRA-CBS can provide supplementary information for predicting the occurrence of HT.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R445.2;R743.33

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