| 王玮娜,王志伟,郑俊江,等.急性缺血性脑卒中溶栓后出血性转化与灌注 CT微血管通透性的相关性[J].安徽医药,2019,23(12):2440-2443. |
| 急性缺血性脑卒中溶栓后出血性转化与灌注 CT微血管通透性的相关性 |
| Predictive value of perfusion CT microvascular permeability in hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke |
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| DOI：10.3969/j.issn.1009?6469.2019.12.027 |
| 中文关键词: 卒中 灌注成像 脑缺血 血栓溶解疗法 /副作用 再灌注 脑出血 体层摄影术，螺旋计算机 毛细血管通透性 预测 |
| 英文关键词: Stroke Capillary permeability Brain ischemia Thrombolytic therapy/adverse effects Reperfusion Cerebral hemorrhage Tomography,spiral computed Perfusion imaging Prediction |
| 基金项目:河北省卫生和计划生育委员会计划项目(20181047) |
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| 中文摘要: |
| 目的探讨急性缺血性脑卒中病人溶栓后出血性转化发生情况及其与灌注 CT微血管通透性的相关性。方法选取 2014年 1月至 2016年 12月在石家庄市第三医院诊断为急性缺血性脑卒中病人 82例作为研究对象，采用回顾性分析法分析所有病人的临床资料，按照资料中治疗后是否发生出血性转化分为未出血组 43例和出血组 39例。所有病人均行头颅 CT检查，分析两组病人病侧灌注 CT的主要参数，绘制受试者工作特征曲线(ROC)对灌注 CT微血管通透性在急性缺血性脑卒中病人溶栓后出血性转化中的预测价值进行分析。结果 ①82例急性缺血性脑卒，中病人溶栓后 39例病人发生出血性转化，发生率为 47.56%；②两组病人年龄、美国国立卫生研究院卒中量表(NIHSS)评分及大面积脑梗死比例比较差异有统计学意义(P＜0.05)； ③出血组病人表面通透性(PS)(15.31±1.45)mL·min-1·(100 g)-1明显高于未出血组病人(10.14±3.61)mL·min-1·(100 g)-1，且出血组病人脑血容量(CBV)和脑血流量(CBF)较未出血者明显较低，比较差异有统计学意义(P＜0.05)； ④根据 ROC曲线结果显示， PS在 ROC曲线下的面积＞ 0.9，诊断界值为 5.86 mL·min-1·(100 g)-1对急性缺血性脑卒中病人溶栓后出血性转化的预测价值灵敏度为 94.72%，特异度为 88.11%；⑤非条件因素 logistic回归模型显示，年，龄较大、 NIHSS评分过高以及出现大面积梗死是导致急性缺血性脑卒中病人溶栓后出血性转化的独立危险因素(P＜0.05)。结论灌注 CT微血管通透性在急性缺血性脑卒中病人溶栓后出血性转化中的预测价值良好，当 PS值大于 5.86 mL·min-1·(100 g)-1时急性缺血性脑卒中病人溶栓后发生出血性转化的风险提高，能为临床静脉溶栓提供重要的参考依据。 |
| 英文摘要: |
| Objective Hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke and perfusion CT mi?crovascular permeability and its correlation.Methods A total of 82 patients diagnosed as acute ischemic stroke in the Third Hos?pital of Shijiazhuang from January 2014 to December 2016 were selected as the study subjects.The clinical data of all patients wereanalyzed retrospectively.According to the data in the treatment of hemorrhagic transformation occurred after they were divided intonon?bleeding group 43 cases and bleeding group 39 cases.All patients were skull CT examination.The main parameters of ipsilater?al CT perfusion in the two groups were analyzed.The ROC curve was drawn and the predictive value of perfusion CT microvascularpermeability on hemorrhagic transformation after thrombolysis in acute ischemic stroke patients was analyzed.Results ① 82 cas? es of acute ischemic stroke patients after thrombolysis，39 patients hemorrhagic transformation occurred，the incidence was 47.56%. ② The age of patients with bleeding group，NIHSS score，large cerebral infarction were significantly greater than the proportion ofnon?bleeding There were significant differences between the two groups(P＜0.05).③ The PS in the bleeding group(15.31±1.45) mL·min-1·(100 g)-1 was significantly higher than that in the non?bleeding group(10.14±3.61)mL·min-1·(100 g)-1，and the CBV and CBF of the bleeding group were significantly lower than those without bleeding(P＜0.05).④ According to the ROC curve re? sults，the area under the ROC curve of PS＞0.9.The diagnostic threshold was 5.86 mL·min-1·(100 g)-1.The predictive value of hem? orrhagic transformation after thrombolysis in acute ischemic stroke patients:the sensitivity was 94.72% and the specificity was88.11%.⑤ The unaged factor logistic regression model analysis showed that older age，high NIHSS score and large area infarctionwere independent risk factors for hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke(P＜0.05). Conclusion Perfusion CT perfusion of CT microvessel has better predictive value for the hemorrhagic transformation after throm?bolysis in patients with acute ischemic stroke.When the PS value is more than 5.86 mL·min-1·(100 g)-1，the hemorrhagic transfor? mation risk increases.It can provide important reference for clinical intravenous thrombolysis. |
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