急性脑梗死后出血性转化患者CT增强扫描参数变化意义

doi:10.7517/issn.1674-0475.210512

摘要/Abstract

摘要： 为探讨急性脑梗死（ACI）后出血性转化（HT）患者CT增强扫描参数变化意义，本研究选取200例ACI患者，根据其是否出现HT分为出血组（n=84）和未出血组（n=116）。分析ACI后HT影响因素及CT增强扫描参数与NIHSS评分相关性，评价CT增强扫描参数对ACI后HT的诊断价值，并观察其预后情况。结果显示，年龄、梗死面积、NIHSS评分、ΔH值、ΔT值、ΔS值均为ACI后HT影响因素（P<0.05），且CT增强扫描参数ΔH值、ΔT值、ΔS值与梗死面积、NIHSS评分呈正相关关系（P<0.05）；CT增强扫描参数联合对ACI后HT的诊断AUC为0.896，具有一定诊断效能，且联合诊断阳性患者90 d病死率高于阴性患者（P<0.05），故CT增强扫描参数可早期诊断ACI后HT，且有助于估计患者预后。

关键词: 急性脑梗死, 出血性转化, CT增强扫描, 诊断, 预后

Abstract: In order to explore the significance of CT enhanced scanning parameters in patients with hemorrhagic transformation (HT) after acute cerebral infarction (ACI), 200 patients with ACI were divided into bleeding group (n=84) and non bleeding group (n=116) according to whether they had HT. The influencing factors of HT after ACI and the correlation between CT enhanced scanning parameters and NIHSS score were analyzed. The diagnostic value of CT enhanced scanning parameters on HT after ACI was evaluated, and the prognosis was observed. It was found that age, infarct area, NIHSS score, ΔH value, ΔT value and ΔS value were the influencing factors of HT after ACI (P<0.05), and the parameters of CT enhanced scanning ΔH value, ΔT value, ΔS value and infarct area NIHSS score was positively correlated (P<0.05). The AUC of CT enhanced scanning parameters combined with HT after ACI is 0.896, which has a certain diagnostic efficiency, and the 90 day mortality of positive patients is higher than that of negative patients (P<0.05). Therefore, CT enhanced scanning parameters can early diagnose HT after ACI and help to estimate the prognosis of patients.

Key words: acute cerebral infarction, hemorrhagic transformation, CT enhanced scan, diagnosis, prognosis

罗志勇, 刘福泉. 急性脑梗死后出血性转化患者CT增强扫描参数变化意义[J]. 影像科学与光化学, 2021, 39(6): 803-807.

LUO Zhiyong, LIU Fuquan. Changes and Significance of Enhanced CT Scanning Parameters in Patients with Hemorrhagic Transformation after Acute Cerebral Infarction[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2021, 39(6): 803-807.

参考文献

[1] Sun Z, Xu Q, Gao G, et al. Clinical observation in edaravone treatment for acute cerebral infarction[J]. Nigerian Journal of Clinical Practice, 2019, 22(10):1324-1327.
[2] 陈南耀, 余丹. 联合检测血清miR-124与miR-182的表达水平对急性脑梗死诊断与预后评估的价值[J]. 中国动脉硬化杂志, 2019, 27(6):502-506.
[3] Mehta T, Hussain M, Sheth K, et al. Risk of hemorrhagic transformation after ischemic stroke in patients with antiphospholipid antibody syndrome[J]. Neurological Research, 2017, 39(6):477-483.
[4] 张琪, 樊凌华. 阿尔伯塔卒中项目早期CT评分和溶栓后出血评分以及相关因素对急性脑梗死溶栓后出血转化的预测价值[J]. 中国中西医结合急救杂志, 2017, 24(4):351-354, 408.
[5] Wang Q, Reps J M, Kostka K F, et al. Development and validation of a prognostic model predicting symptomatic hemorrhagic transformation in acute ischemic stroke at scale in the OHDSI network[J]. PLoS One, 2020, 15(1):e0226718.
[6] 张江, 王瑶, 张喆鉴. 弥散加权成像Alberta卒中项目早期CT评分评估急性前循环脑梗死静脉溶栓预后的价值[J]. 中华老年心脑血管病杂志, 2018, 20(1):60-63.
[7] 蔡青云. 多层螺旋CT(MSCT)对超急性大面积脑梗死的诊断及鉴别价值[J]. 中国CT和MRI杂志, 2018, 16(12):14-16.
[8] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
[9] Eskioglou E, Huchmandzadeh Millotte M, Amiguet M, et al. National institutes of health stroke scale zero strokes[J].Stroke, 2018, 49(12):3057-3059.
[10] 盛良驹, 赵天, 高传美, 等. 头颅CT灌注成像对急性脑梗死后出血转化预测的价值[J]. 临床放射学杂志, 2020, 39(2):256-260.
[11] 孙丽娜. 头颅CTA联合CTP在急性脑梗死后出血性转化预测中的应用[J]. 内蒙古医科大学学报, 2020, 42(2):135-139.
[12] García-Culebras A, Palma-Tortosa S, Moraga A, et al. Toll-like receptor 4 mediates hemorrhagic transformation after delayed tissue plasminogen activator administration in in situ thromboembolic stroke[J].Stroke, 2017, 48(6):1695-1699.
[13] Hao Y G, Zhang Z Z, Zhang H, et al. Risk of intracranial hemorrhage after endovascular treatment for acute ischemic stroke:Systematic review and meta-analysis[J].Interventional Neurology, 2017, 6(1-2):57-64.
[14] Li X Q, Li L, Li C Q, et al. Efficacy and safety of desmoteplase in acute ischemic stroke patients:A systematic review and meta-analysis[J].Medicine (Baltimore), 2017, 96(18):e6667.
[15] 朱珏华, 韩春艳, 李润楠, 等. 重组组织型纤溶酶原激活剂静脉溶栓后症状性颅内出血风险评估量表的对比研究[J]. 中华神经科杂志, 2019, 52(12):1022-1030.
[16] 徐阳, 金凡夫, 赵丽, 等. 急性脑梗死静脉溶栓前后美国国立卫生研究院卒中量表评分与收缩压变化值在颅内出血性转化中的预测价值[J].安徽医药, 2021, 25(2):250-254.