急性大脑中动脉闭塞患者高信号血管征与脑灌注的相关性研究
发布时间：2018-06-23 04:06
本文选题：急性脑梗死 + 高信号血管征 ； 参考：《皖南医学院》2017年硕士论文
【摘要】：目的:高信号血管征(hyperintense vessel sign,HVS)是缺血性脑血管病患者颅内侧支循环在磁共振液体衰减反转恢复序列(fluid-attenuated inversion recovery,FLAIR)上的影像学表现,其与局部脑血流灌注的关系尚不明确。本文以急性大脑中动脉闭塞患者为研究对象,旨在探讨HVS与局部脑血流灌注的相关性。方法:纳入2015年10月至2016年12月期间于皖南医学院弋矶山医院神经内科住院治疗的急性大脑中动脉闭塞患者,共54例。所有患者需在入院后48小时内行头颅CT、头颅磁共振成像(包括DWI序列和FLAIR序列)、头颅磁共振血管成像(magetic resonace aniography,MRA)、CT灌注成像(CT perfusion,CTP)检查。收集记录患者一般临床资料信息(包括性别、年龄、既往病史、入院时NIHSS评分、ASPECT评分等)、实验室检查结果(包括血糖、血脂、血尿酸等)及影像学检查结果(CT、MRI、MRA、CTP),并随访记录患者30天改良的Rankin(modified Rankin Scale,mRS)评分。在MRI FLAIR序列上观察HVS,并根据CTP获取梗死侧与健侧镜像区灌注参数值,包括脑血流量(cerebral blood flood,CBF)、脑血容量(cerebral blood volume,CBV)、达峰时间(time to peak,TTP)及平均通过时间(mean transit time,MTT),随后用Spearman相关分析HVS分值和CTP各参数值之间的相关性。结果:(1)共入组54例大脑中动脉闭塞患者,平均年龄62.19±13.53岁,其中男性36例(66.67%)、高血压病36例(66.67%)、糖尿病17例(31.48%)、冠心病10例(18.52%)、吸烟18例(33.33%)、酗酒11例(20.37%)、大脑中动脉闭塞区域HVS阳性者共43例(79.63%)、HVS阴性者共11例(20.37%);(2)HVS阳性组患者梗死侧与健侧镜像区比较,CBF、CBV降低(t=-2.376,P=0.020;t=-2.980,P0.01),TTP延长(t=4.537,P0.01),而MTT延长无统计学意义(t=0.237,P0.05);HVS阴性组患者梗死侧与健侧镜像区相比,CBF、CBV明显降低(t=-4.043,P0.01;t=-3.996,P0.01),MTT及TTP均显著延长(t=2.194,P=0.040;t=2.182,P=0.044);(3)Spearman相关分析显示,大脑中动脉闭塞区域CBF、CBV值与HVS分值呈正相关(r=0.590,P0.01;r=0.502,P0.01),MTT与HVS分值呈负相关性(r=-0.329,P=0.015),TTP与HVS分值无相关性(r=-0.207,P=0.133);(4)HVS阳性组患者入院NIHSS评分及30dmRS评分均低于HVS阴性组(t=2.895,P0.01;Z=-2.060,P=0.039),ASPECT评分高于HVS阴性组(Z=-2.024,P=0.043);(5)单因素分析显示,两组间糖尿病(?2=5.750,P=0.016)、血清总胆固醇(t=2.041,P=0.046)、甘油三酯(t=2.029,P=0.048)存在显著差异;(6)多因素Logistic回归分析显示,糖尿病是影响大脑中动脉闭塞患者HVS形成的独立危险因素(OR=4.758,95%CI1.053~21.502,P0.05)。结论:急性大脑中动脉闭塞患者HVS的出现预示着缺血区域脑组织灌注良好,且患者预后较好。糖尿病是影响急性大脑中动脉闭塞患者头颅磁共振FLAIR序列HVS形成的独立危险因素。
[Abstract]:Objective: high signal vascular sign (hyperintense vessel) is the imaging manifestation of intracranial collateral circulation in patients with ischemic cerebrovascular disease on fluid-attenuated inversion recovery sequence of fluid attenuated inversion (FLAIR), and its relationship with regional cerebral blood flow perfusion is not clear. The purpose of this study was to investigate the correlation between HVS and regional cerebral blood perfusion in patients with acute middle cerebral artery occlusion. Methods: from October 2015 to December 2016, 54 patients with acute middle cerebral artery occlusion (MCAO) were admitted to the Department of Neurology, Yiji Mountain Hospital, Southern Anhui Medical College. All patients should be performed CT perfusion imaging (CT perfusion imaging) within 48 hours after admission, head magnetic resonance imaging (including DWI sequence and flair sequence) and cranial magnetic resonance angiography (magetic resonace) perfusion imaging (CTP). Collect and record general clinical information (including gender, age, past medical history, NIHSS score on admission, ASPECT score, etc.), laboratory results (including blood sugar, blood lipid, etc.), Serum uric acid (UA) and imaging findings (CTN MRI MRACTP), and the modified Rankin scale score were recorded after 30 days follow-up. The HVS was observed on flair MRI sequence, and the perfusion parameters of the infarct side and the contralateral mirror region were obtained according to CTP. Including cerebral blood flow (cerebral blood), cerebral blood volume (cerebral blood), peak time (time to) and mean transit time (mean transit time). Then Spearman correlation was used to analyze the correlation between the scores of (cerebral blood and the parameters of (time to. Results: (1) 54 patients with middle cerebral artery occlusion (MCAO) were enrolled. The mean age was 62.19 卤13.53 years old. Of them, 36 (66.67%) were male, 36 (66.67%) were hypertension, 17 (31.48%) were diabetes, 10 (18.52%) were coronary heart disease, 18 (33.33%) were smoking, 11 (20.37%) were alcoholism, 43 (79.63%) were HVS-negative in middle cerebral artery occlusion region, 11 (20.37%) were HVS-negative. The CBFCBV was significantly decreased in the CBFV negative group compared with that in the normal mirror region (tnr -2.376P0. 020t- 2.980m P0.01), but no significant difference was found in the prolongation of the CBV (t 2. 194 P0. 182 P0. 182 P0. 044); (3). The results of Spearman correlation analysis showed that the CBFCBV in the infarct side of the HVS-negative group was significantly lower than that in the normal mirror image region (t 4. 043 P0. 091 t-3) and the TTP was significantly prolonged (t 2. 194 P0. 040 t 2. 182P 0. 044); (3), the results showed that the CBFCBV in the infarct side of the HVS-negative group was significantly lower than that in the normal mirror image area (t = 4. 043, P = 0. 091, P < 0. 01). 澶ц剳涓姩鑴夐棴濉炲尯鍩烠BF,CBV鍊间笌HVS鍒嗗，
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