Predictive value of collateral circulation score based on multi-phase CT angiography and plasma D-dimer to fibrinogen ratio in patients with acute ischemic stroke caused by middle cerebral artery occlusion
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万方数据
维普
目的:探讨多时相CTA侧支循环评分联合血浆D-二聚体与纤维蛋白原(FIB)的比值(D/F)在预测大脑中动脉闭塞急性缺血性脑卒中(AIS)患者预后中的价值.方法:选择2021年10月—2024年4月在本院确诊为大脑中动脉闭塞AIS的102例住院患者作为研究对象,使用Toshiba Aqui-lion ONE 320排螺旋CT机进行头颅CT扫描.根据CT灌注成像原始图像中的动脉期、静脉期和静脉晚期定义多时相CTA.采用CTP脑灌注智能分析系统自动获得核心梗死体积和低灌注体积.采用Menon评分法(0～5分)对多时相CTA上侧支血管的情况进行评分.测量血浆D二聚体和FIB水平,计算两者比值(D/F).根据治疗后3个月时改良Rankin量表(mRS)评分将患者分为预后良好组(45例)和预后不良组(57例).采用t或x2检验对两组患者的一般资料、多时相CTA侧支循环评分、核心梗死体积和低灌注体积进行比较.采用多因素Logistic回归分析影响AIS患者预后的独立危险因素.采用受试者特征曲线(ROC)分析CTA侧支循环评分及对血浆D/F预测大脑中动脉闭塞AIS患者预后的效能结果:相较于预后良好组,预后不良组患者的糖尿病患病比例显著升高(P＜0.05),多时相CTA侧支循环评分显著降低(P＜0.001)血浆D/F显著升高(P＜0.001).Pearson相关性分析结果显示,AIS患者多时相CTA侧支循环评分与血浆D/F呈显著负相关(r=-0.350,P＜0.001).多时相CTA侧支循环评分和血浆D/F单独预测AIS患者预后不良的AUC分别为0.760(95％CI:0.668～0.851,P＜0.001)、0.820(95％CI:0.741～0.899,P＜0.001);两者联合时 AUC 为 0.868(95％CI:0.801～0.935,P＜0.001),相应的诊断敏感度为82.5％,特异度为77.8％.结论:多时相CTA侧支循环评分联合血浆D二聚体与纤维蛋白原的比值对大脑中动脉闭塞AIS患者的预后具有一定预测价值.
Objective:To investigate the value of collateral circulation score based on multi-phase CT angiography(CTA)combined with plasma D-dimer to fibrinogen ratio(D/F)in predicting prog-nosis of patients with acute ischemic stroke(AIS)caused by middle cerebral artery occlusion.Methods:102 patients diagnosed as middle cerebral artery occlusion AIS in our hospital from October 2021 to April 2024 were selected as the study objects.The Toshiba Aquilion ONE 320-row spiral CT scanner was used to perform head CT scan,and multi-phase CTA was defined based on the cerebral ar-tery phase,cerebral vein phase and cerebral vein late phase in the original images of CT perfusion ima-ging.The core infarct volume and hypoperfusion volume were obtained automatically by CTP intelli-gent cerebral perfusion analysis system.Menon score method(0 to 5 points)was used to score the up-per collateral vessels of multi-temporal CTA.Plasma D-dimer and FIB levels were measured and the ratio of them(D/F)was calculated.According to the modified Rankin Scale(mRS)score 3 months af-ter treatment,the patients were divided into a good prognosis group(45 cases)and a poor prognosis group(57 cases).The clinical data,multi-phase CTA collateral circulation score,core infarction volume and hypoperfusion volume were compared between the two groups using t-or x2-test.Multivariate lo-gistic regression analysis was used to analyze the independent risk factors for the prognosis of AIS pa-tients.Receiver operation characteristic curve(ROC)was used to analyze the efficacy of CTA collate-ral circulation score and plasma D/F in predicting the prognosis of AIS patients with middle cerebral artery occlusion.Results:Compared with the good prognosis group,the proportion of diabetes in the poor prognosis group was significantly increased(P＜0.05),and the multi-phase CTA collateral circu-lation score was significantly decreased(P＜0.001).Plasma D/F was significantly increased(P＜0.001).Pearson correlation analysis showed that there was a significant negative correlation between multi-phase CTA collateral circulation score and plasma D/F in AIS patients(r=-0.350,P＜0.001).The AUC of multi-phase CTA and plasma D/F alone in predicting poor prognosis of AIS patients was 0.760(95％CI:0.668～0.851,P＜0.001)and 0.820(95％CI:0.741～0.899,P＜0.001),respectively.The combined AUC was 0.868(95％CI:0.801～0.935,P＜0.001),the corresponding diagnostic sensi-tivity was 82.5％,and the specificity was 77.8％.Conclusion:The multi-phase CTA collateral circula-tion score combined with the ratio of plasma D-dimer to fibrinogen has certain predictive value for the prognosis of AIS patients with middle cerebral artery occlusion.
万方数据
维普
