| 卜静英,高铎,袁涛,等.SWI-DWI不匹配在急性缺血性脑卒中病人静脉溶栓预后评估中的价值分析[J].安徽医药,2025,29(7):1359-1364. |
| SWI-DWI不匹配在急性缺血性脑卒中病人静脉溶栓预后评估中的价值分析 |
| Value of SWI-DWI mismatch in the prognosis assessment of intravenous thrombolysis in patients with acute ischemic stroke |
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| DOI：10.3969/j.issn.1009-6469.2025.07.018 |
| 中文关键词: 卒中 磁共振成像 磁敏感加权成像 -弥散加权成像( SWI-DWI) 组织型纤溶酶原激活剂 预后 |
| 英文关键词: Stroke Magnetic resonance imaging Sensitivity weighted imaging-diffusion weighted imaging (SWI-DWI) Tissue-type plasminogen activator Prognosis |
| 基金项目:河北省卫生健康委员会医学研究课题项目( 20190539) |
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| 中文摘要: |
| 目的探讨磁敏感加权成像(SWI)-弥散加权成像(DWI)不匹配在急性缺血性脑卒中(AIS)病人静脉溶栓预后评估中的价值。方法前瞻性筛选 2019年 5月至 2020年 10月在河北医科大学第二医院就诊的 AIS病人 109例，全部行磁共振成像(MRI)静脉溶栓治疗后随访 3个月，根据预后情况将病人分为良好组( n=73)和不良组( n=36)。比较两组的影像学参数及临床资料，并，经 logistic回归模型分析影响 AIS病人静脉溶栓治疗预后不良的危险因素。结果随访 3个月， 109例病人中预后不良 36例、预后良好 73例；预后不良组 SWI-Alberta卒中项目早期计算机断层扫描评分( ASPECTS)为( 5.11±1.40)分，良好组为(4.67±0.99)分，两组比较差异统计学意义( P>0.05)；不良组的改良脑梗死溶栓分级( mTICI)重度狭窄占比高于良好组， SWI-DWI不匹配占比则低于良好组，不良组 DWI-ASPECTS评分为( 4.89±1.04)分低于良好组( 6.60±1.57)分( P<0.05)。不良组入院美国国立卫生院神经功能缺损(NIHSS)评分、发病至 MRI检查时间及白细胞计数、低密度脂蛋白胆固醇( LDL-C)水平高于良好组( P<0.05)。多因素 logistic回归模型显示，入院 NIHSS评分高是导致 AIS病人静脉溶栓预后不良的独立危险因素，而高 DWI-ASPECTS评分和 SWI-DWI不匹配是 AIS病人预后良好的保护因素( P<0.05)。结论 SWI-DWI序列不匹配对 AIS病人静脉溶栓预后具有一定的诊断价值，可作为 AIS病人预后评估的一种简单易行的影像学方法。 |
| 英文摘要: |
| Objective To investigate the value of magnetic sensitivity weighted imaging (SWI) -diffusion weighted imaging (DWI)mismatch in the prognosis assessment of intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods Prospectivescreening was performed on 109 AIS patients admitted to the Second Hospital of Hebei Medical University from May 2019 to October2020. All patients underwent magnetic resonance imaging (MRI) and were followed up for 3 months after intravenous thrombolysis. Pa-tients were assigned into good group (n=73) and bad group (n=36) according to prognosis. The imaging parameters and clinical data ofthe two groups were compared, and the risk factors affecting the poor prognosis of patients with AIS after intravenous thrombolysis wereanalyzed by logistic regression model.Results After 3 months of follow-up, 36 of the 109 patients had poor prognosis and 73 had good prognosis. The early computed tomography score (ASPECTS) of the SWI-Alberta Stroke project in the poor prognosis group was (5.11±1.40) points, and that in the good group was (4.67±0.99) points, and the difference between the two groups was statistically significant(P > 0.05). The proportion of modified thrombolysis in cerebral infarction (mTICI) severe stenosis in the poor group was higher than thatin the good group, while the proportion of SWI-DWI mismatch was lower than that in the good group. The DWI-ASPECTS score of the poor group was (4.89±1.04) points, which was lower than that of the good group (6.60±1.57) points (P<0.05). The neurological impair-ment (NIHSS) score, the time from onset to MRI, white blood cell count (WBC) and low density lipoprotein cholesterol (LDL-C) level in the poor group were higher than those in the good group (P<0.05). Multivariate Logistic regression model showed that high admissionNIHSS score was an independent risk factor for poor prognosis of AIS patients with intravenous thrombolysis, while high DWI-AS-PECTS score and SWI-DWI mismatch were protective factors for good prognosis of AIS patients (P<0.05).Conclusion SWI-DWI se-quence mismatch has a certain diagnostic value for the prognosis of AIS patients with intravenous thrombolysis, and can be used as asimple and easy imaging method to evaluate the prognosis of AIS patients. |
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