摘要
目的探讨磁共振弥散加权成像Alberta卒中项目早期CT评分(DWI-ASPECTS)对急性前循环脑梗死静脉溶栓治疗预后的预测价值。方法选择接受静脉溶栓的急性前循环脑梗死患者99例,根据溶栓3个月后改良的Rankin量表(mRS)评分分为2组,mRS评分0~2分为良好转归组66例,3~6分为不良转归组33例。收集患者的一般临床资料、DWI-ASPECTS评分、溶栓3个月后mRS、溶栓3个月后改良的Barthel指数(MBI)以及并发症情况。结果与不良转归组比较,良好转归组年龄和入院美国国立卫生研究院卒中量表(NIHSS)评分显著降低,DWI-ASPECTS评分显著升高(P<0.05)。logistic回归分析显示,年龄(OR=1.097,95%CI:1.019~1.180,P=0.013)、入院NIHSS评分(OR=1.207,95%CI:1.025~1.421,P=0.024)、DWI-ASPECTS评分(OR=0.543,95%CI:0.343~0.858,P=0.009)是不良转归发生的独立预测因素。DWI-ASPECTS评分曲线下面积为0.887(95%CI:0.822~0.951),预测不良转归的最佳临界点为5.5,敏感性为84.8%,特异性为81.8%。DWI-ASPECTS评分与MBI呈正相关(P=0.000)。列联分析显示,DWI-ASPECTS评分与血管再闭塞、出血、缺血再灌注损伤存在相关性(P<0.01)。结论 DWI-ASPECTS评分是评估急性前循环脑梗死患者静脉溶栓治疗预后转归的重要指标。
Objective To study the value of DWI-ASPECTS in predicting the outcomes of intravenous thrombolysis-treated patients with AACCI.Methods Ninety-nine intravenous thrombolysistreated AACCI patients were divided into good outcome group with 0-2 mRS scores（n=66）and poor outcome group with 3-6 mRS scores（n=33）.Their clinical data,DWI-ASPECTS score,mRS score,MBI were recorded after 3 months of intravenous thrombolysis treatment.ResultsThe age was younger,the NIHSS score was significantly lower while the DWI-ASPECTS score was significantly higher in good outcome group than in poor outcome group on admission（P〈0.05）.Logistic regression analysis showed that age,NIHSS score and DWI-ASPECTS score on admission were the independent predictors for poor outcomes of intravenous thrombolysis-treated AACCI patients（P〈0.05）.The area under the ROC curve for DWI-ASPECTS score was 0.887（95%CI：0.822-0.951）.The best critical value of DWI-ASPECTS in predicting the poor outcome of intravenous thrombolysis-treated AACCI patients was 5.5 with a sensitivity of 84.8%and a specificity of 81.8%.The DWI-ASPECTS score was positively related with the MBI（P=0.000）.The DWI-ASPECTS score was related with the blood vessel reocclusion,hemorrhage,and I/R injury（P〈0.01）.Conclusion DWI-ASPECTS score is an independent predictor for the outcomes of intravenous thrombolysis-treated AACCI patients.
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2018年第1期60-63,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
关键词
磁共振成像
弥散
脑梗死
再灌注损伤
预后
diffusion magnetic resonance imaging
brain infarction
reperfusion injury
prognosis
