摘要
目的 探讨全脑CT灌注(CTP)成像参数及血清基质金属蛋白酶-9(MMP-9)水平在急性脑梗死(ACI)血管内治疗后出血转化中的预测意义.方法 以武汉市第一医院2021年6月至2022年9月收治的46例行血管内支架机械取栓治疗的ACI患者为回顾性研究对象.血管内治疗前行常规CT平扫、CTP及血清MMP-9检查,计算CTP患侧与健侧对称部位比值得到相对参数值:相对脑血容量(rCBV)、相对脑血流量(rCBF)、相对平均通过时间(rMTT)、相对达峰时间(rTTP)和相对表面渗透性(rPS).根据治疗7 d内复查的CT平扫图像有无发生出血转化分为出血组和未出血组.采用Spearman秩相关分析CTP参数、血清MMP-9水平与出血转化的相关性,并评估其对ACI血管内治疗后出血转化的预测效能.结果 46例患者中,12例发生出血转化(出血组),34例未发生出血转化(未出血组).出血组rCBV、rCBF较未出血组患者低,rPS、PS、rTTP、MMP-9较未出血组高,差异有统计学意义(P＜0.05);两组rMTT差异无统计学意义(P＞0.05).rPS、PS、rTTP、MMP-9分别与出血转化呈正相关(P＜0.01),rCBV、rCBF分别与出血转化呈负相关(P＜0.01);其中MMP-9与出血转化相关性最强(r=0.752,P＜0.01),rPS 次之(r=0.664,P＜0.01).rCBV、rCBF、rTTP、PS、rPS 和 MMP-9 预测出血转化的 ROC 曲线下面积(AUC)分别为0.794、0.755、0.750、0.848、0.936和0.863,以rPS最高.结论 CTP参数变化及血清MMP-9增高在预测ACI血管内治疗后出血转化中有重要意义,可为患者血管内治疗提供指导.
Abstract
Objective To explore the value of whole brain CT perfusion(CTP)imaging parameters and serum MMP-9 level in predicting hemorrhagic transformation(HT)after endovascular therapy of acute cerebral infarction(ACI).Methods A retrospective study was conducted on 46 patients with ACI who underwent endovascular stent mechanical thrombectomy in Wuhan No.1 Hospital from June 2021 to September 2022.Routine CT plain scan,CTP,and serum MMP-9 examination were performed before endovascular treatment,and the symmetrical site ratio between the affected side and the unaffected side of CTP was calculated to obtain the relative parameter values:relative cerebral blood volume(rCBV),relative cerebral blood flow(rCBF),relative mean transit time(rMTT),relative time to peak(rTTP)and relative permeability surface(rPS).According to whether the CT images re-examined within 7 days of treatment had HT,the patients were divided into HT group and non-HT group.Spearman rank correlation analysis was used to analyze the correlation of HT with CTP parameters and serum MMP-9 level,and to evaluate the predictive efficacy of the two indexes on HT after endovascular treatment of ACI.Results Of the 46 patients,HT occurred in 12 patients and non-HT in 34 patients.Compared with non-HT group,rCBV and rCBF decreased,while rPS,PS,rTTP and MMP-9 increased in HT group(P＜0.05).However,there was no statistically significance of rMTT between the two groups(P＞0.05).rPS,PS,rTTP and MMP-9 were positively correlated with HT(P＜0.01),and rCBV and rCBF were negatively correlated with HT(P＜0.01),respectively.Among them,MMP-9 was most strongly correlated with HT(r=0.752,P＜0.01),followed by rPS(r=0.664,P＜0.01).The area under curve(AUC)of rCBV,rCBF,rTTP,PS,rPS and MMP-9 in predicting HT was 0.794,0.755,0.750,0.848,0.936 and 0.863,respectively,with rPS being the highest.Conclusion The changes in CTP parameters and the increase of serum MMP-9 level are of great significance in predicting the HT after endovascular treatment of ACI,which can provide a guidance for endovascular treatment of patients.
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