摘要
目的 合并大血管闭塞(LVO)的急性缺血性卒中(AIS)患者中约有10%表现为轻型脑卒中,在未接受再灌注治疗的轻型脑卒中患者中,约20%会出现神经功能恶化。本文将基于MRI,探讨预测前循环大血管闭塞引起的轻型卒中患者出现早期神经功能恶化(END)的影像学指标。方法 连续收集2021年1月1日—2024年12月30日在河南省人民医院诊断为脑梗死且发病时间在72 h内的急性前循环梗死住院患者84例,采用3.0T磁共振对急性脑梗死患者进行灌注加权成像(PWI)和弥散加权成像(DWI)检查。所有患者入院24 h内美国国立卫生研究院卒中量表基线评分(NIHSS评分)≤5分,且均未接受血管内治疗。收集患者的PWI和DWI影像及检查结果,分析局部脑血流量(rCBF)、局部脑血容量(rCBV)、平均通过时间(MTT)、达峰时间(TTP)。采用受试者工作特征(ROC)曲线分析PWI参数对未接受血管内治疗的前循环大血管闭塞的轻型脑卒中患者出现早期神经功能恶化的预测价值;连续性变量根据Youden指数的最佳截断值分层,采用多因素Logistic回归分析探讨END的独立危险因素。结果 END发生率31.0%,影像学指标为rCBF比例(截断值:29.3%)。rCBF比例(OR=14.41,95%CI 7.00~37.33)是END的独立危险因素。结论 rCBF比例≥29.3%对伴前循环大血管闭塞的轻型脑卒中患者的早期神经功能恶化具有一定的预测价值,是其独立危险因素。
Objective Approximately 10%of patients with acute ischemic stroke(AIS)due to large vessel occlu⁃sion(LVO)present with mild stroke,and about 20%of the patients with mild stroke who do not receive reperfusion treat⁃ment will experience early neurological deterioration.This study aims to investigate the imaging indicators for predicting the onset of early neurologic deterioration(END)in patients with mild stroke due to LVO in the anterior circulation based on magnetic resonance imaging.Methods A total of 84 hospitalized patients who were diagnosed with acute anterior cir⁃culation infarction within 72 hours after disease onset in Henan Provincial People’s Hospital from January 1,2021 to De⁃cember 30,2024 were enrolled,and 3.0 T magnetic resonance imaging was used to perform perfusion-weighted imaging(PWI)and diffusion-weighted imaging(DWI)for all patients with acute cerebral infarction.All patients had a baseline Na⁃tional Institutes of Health Stroke Scale(NIHSS)score of≤5 within 24 hours after admission,and none of them received en⁃dovascular treatment.PWI and DWI imaging findings were collected from all patients to analyze regional cerebral blood flow(rCBF),regional cerebral blood volume,mean transit time,and time to peak.The receiver operating characteristic curve was plotted to analyze the value of PWI parameters in predicting END in patients with mild stroke due to LVO in the anterior circulation who did not receive endovascular treatment.Continuous variables were stratified based on the optimal cut-off value of Youden index,and the multivariate logistic regression analysis was used to investigate the independent risk factors for END.Results The incidence rate of END was 31.0%,with the proportion of rCBF as the imaging indicator,cut-off value 29.3%.The proportion of rCBF was an independent risk factor for END(OR=14.41,95%CI 7.00–37.33).Conclusion The proportion of rCBF≥29.3%has a certain value in predicting END in patients with mild stroke due to LVO in the anterior circulation and is an independent risk factor.
作者
高言梅
张秀雅
师晶晶
聂肖肖
赵建华
GAO Yanmei;ZHANG Xiuya;SHI Jingjing;NIE Xiaoxiao;ZHAO Jianhua(Department of Neu-rology,People’s Hospital of Henan University,Zhengzhou 450003,China;Department of Neurology,Henan Provincial People’s Hospital,Zhengzhou 450003,China)
出处
《中风与神经疾病杂志》
2026年第2期160-166,共7页
Journal of Apoplexy and Nervous Diseases
基金
河南省医学科技攻关计划项目(SBGJ202102034)
河南省科技计划重点项目(222102310177)。
关键词
早期神经功能恶化
磁共振成像
轻型卒中
急性缺血性卒中
大血管闭塞
Early neurological deteriora⁃tion
Magnetic resonance imaging
Mild stroke
Acute ischemic stroke
Large vessel occlusion
