分区脑血流量与急性缺血性脑卒中再灌注治疗后出血转化的相关性研究
The Association between Perfusion Parameter of Different Brain Regions and Hemorrhagic Transformation after Reperfusion Therapy of Patients with Acute Ischemic Stroke
刘心雨 1洪澜 1李思源 1贺智娇 1王心如 1张怡然 1程忻 1董强1
作者信息
- 1. 复旦大学附属华山医院神经内科,上海 200040;国家神经疾病医学中心,上海 200040
- 折叠
摘要
目的 探讨前循环近端大血管狭窄或闭塞急性缺血性脑卒中患者的基线分区脑血流量与再灌注治疗后出血转化之间的相关性.方法 回顾性收集2015年4月至2023年1月于复旦大学附属华山医院神经内科进行急诊再灌注治疗的前循环近端大血管狭窄或闭塞性脑卒中患者的临床及影像资料,根据随访CT评估是否存在出血转化.基线灌注CT经过人工智能软件F-STROKE后处理划分Alberta卒中项目早期CT评分(ASPECTS)感兴趣区(ROI),并获取各ROI内脑血流量中位数,将患侧与健侧脑血流量比值定义为脑血流镜像指数(CBFmi).通过向后逐步回归分析寻找独立影响因素,用受试者工作特征曲线(ROC)预测出血转化变量的最佳截断值.结果 纳入290例患者,其中女性102例(35.2%),中位年龄71(60,78)岁,中位NIHSS评分13(8,17)分.较低的岛叶(I)-CBFmi是再灌注治疗后发生任意出血转化的独立危险因素(OR=0.12,95%CI:0.03～0.42,P<0.001).根据ROC曲线将I-CBFmi<0.74定义为岛叶不良灌注.岛叶不良灌注患者发生任意出血转化(OR=3.36,95%CI:1.77～6.36,P<0.001)和脑实质血肿(OR=2.46,95%CI:1.22～4.96,P=0.012)的风险较高.结论 岛叶不良灌注是前循环大血管狭窄或闭塞性脑卒中患者再灌注治疗后发生出血转化的独立危险因素.
Abstract
Aim To explore the association of perfusion parameters of different brain regions with hemorrhagic transformation(HT)in patients with acute ischemic stroke due to large vessel stenosis or occlusion.Methods Acute ischemic stroke patients presented with proximal large vessel stenosis or occlusion and received reperfusion treatment at the department of neurology,Huashan Hospital from April 2015 to January 2023 were retrospectively included.HT was evaluated using 24-hour repeated non-contrast CT.CT perfusion source images were post-processed with F-STROKE and co-registered to the standard Alberta Stroke Program Early CT Score(ASPECTS)template.Absolute cerebral blood flow(CBF)was calculated separately of each region of interest and the ratio of CBF on the affected side to the contralateral side was defined as the CBF mirror index(CBFmi).Backward stepwise Logistic regression analysis was used to explore the independent variables and receiver operating characteristic(ROC)curve analysis was used to explore the optimal cutoff of regional CBFmi predicting HT.Results A total number of 290 patients were included,with 102 females(35.2%).The median(IQR)age was 71(60,78)years and the median(IQR)baseline National Institute of Health Stroke Scale(NIHSS)score was 13(8,17).Backward stepwise Logistic regression analysis revealed that a lower CBFmi of the insular ribbon(I-CBFmi)was associated with an increased risk of any HT after reperfusion therapy(OR=0.12,95%CI:0.03-0.42,P<0.001).I-CBFmi<0.74 was defined as unfavorable perfusion of insular ribbon according to ROC analysis.Stepwise Logistic regression revealed unfavorable perfusion of insular ribbon as an independent risk factor for any HT(OR=3.36,95%CI:1.77-6.36,P<0.001)and parenchymal hematoma(OR=2.46,95%CI:1.22-4.96,P=0.012).Conclusion An unfavorable perfusion of insular ribbon was correlated with increased risk of HT after reperfusion therapy of stroke patients with large vessel stenosis or occlusion.
关键词
缺血性脑卒中/再灌注/出血转化/脑血流量Key words
stroke/reperfusion/hemorrhagic transformation/cerebral blood flow引用本文复制引用
基金项目
国家自然科学基金(82271352)
上海市科委"科技创新行动计划"医学创新研究专项(20Z11900802)
出版年
2024
NETL
NSTL
万方数据