基于扩散加权成像的Alberta卒中项目早期CT评分对急性脑梗死患者静脉溶栓治疗预后的评估价值

来源:用户上传      作者:蔡泽银，黄泗芳，徐建怀

　　摘要：目的：探讨基于扩散加权成像的Alberta卒中项目早期CT评分（DWI-ASPECTS）对急性脑梗死（ACI）患者静脉溶栓治疗预后的评估价值。方法：选取2018年2月-2021年2月在本院确诊的80例ACI患者均进行静脉溶栓治疗。3个月后根据改良Rankin量表评分将其分为预后良好组（n=53）和预后不良组（n=27）。收集勺榛颊叩牧俅沧柿希比较两组入院时NIHSS评分和DWI-ASPECTS 评分的差异，Logistic回归分析影响ACI患者预后不良的危险因素，采用受试者工作特征曲线（ROC）分析DWI-ASPECTS 评分对ACI患者预后的预测价值。结果：两组患者的年龄、合并糖尿病、溶栓后出血和溶栓后缺血再灌注损伤与预后不良组患者相比差异显著（P<0.05）。预后不良组患者入院时NIHSS评分与预后良好组无显著差异（P>0.05），预后不良组患者DWI-ASPECTS评分低于预后良好组（P<0.05）。Logistic回归分析显示，年龄>60岁、溶栓后缺血再灌注损伤和DWI-ASPECTS≤7分是影响ACI患者预后不良的独立危险因素（P<0.05）。ROC曲线分析显示，DWI-ASPECTS评分预测ACI预后不良的曲线下面积（AUC）为0.890（P<0.05）。结论：ACI患者预后不良与年龄、溶栓后并发症有关，临床可通过DWI-ASPECTS 评分预测ACI患者的预后。
　　关键词：扩散加权成像的Alberta卒中项目早期CT评分;急性脑梗死;静脉溶栓;预后
　　中图分类号：R743.3 文献标识码：B DOI：10？郾3969/j.issn.1001-0270.2022.01.14
　　Evaluation Value of Alberta Stroke Programme Early CT Score on Diffusion-weighted Imaging for the Prognosis of Patients with Acute Cerebral Infarction Undergoing Intravenous Thrombolysis
　　CAI Ze-yin， HUANG Si-fang， XU Jian-huai
　　（Department of Imaging， Shanwei People's Hospital， Guangdong 516600， China）
　　Abstract： Objective： To explore the evaluation value of Alberta stroke programme early CT score on diffusion-weighted imaging（DWI-ASPECTS） for the prognosis of patients with acute cerebral infarction（ACI） undergoing intravenous thrombolysis. Methods： A total of 80 patients with ACI confirmed in the hospital were enrolled between February 2018 and February 2021. All underwent intravenous thrombolysis. Three months later， they were divided into good prognosis group（n=53） and poor prognosis group（n=27） according to scores of modified Rankin scale. The clinical data in both groups were collected. The differences in scores of NIHSS and DWI-ASPECTS at admission between the two groups were compared. The risk factors of poor prognosis were analyzed by Logistic regression analysis. The predictive value of DWI-ASPECTS score for prognosis of ACI patients was analyzed by receiver operating characteristic（ROC） curves. Results： The differences in age， diabetes mellitus， bleeding and ischemia-reperfusion injury after thrombolysis between the two groups were statistically significant（P<0.05）. There was no significant difference in NIHSS score at admission between poor prognosis group and good prognosis group（P>0.05）. DWI-ASPECTS score in poor prognosis group was lower than that in good prognosis group（P<0.05）. Logistic regression analysis showed that age>60 years， ischemia-reperfusion injury after thrombolysis and DWI-ASPECTS≤7 points were independent risk factors of poor prognosis in ACI patients（P<0.05）. ROC curves analysis showed that the area under the curve （AUC） of DWI-ASPECTS score for redicting poor prognosis was 0.890（P<0.05）. Conclusion： The poor prognosis of ACI patients is related to age and complications after thrombolysis. Clinically， prognosis of ACI patients can be predicted by DWI-ASPECTS scores.
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