摘要
目的观察多模态CT联合临床指标预测急性缺血性脑卒中(AIS)合并2型糖尿病(T2DM)患者认知障碍(CD)的价值。方法回顾性收集346例AIS合并T2DM,按7∶3比例划分训练集(n=242)与验证集(n=104),并根据出院后6个月蒙特利尔认知评估(MoCA)量表评分于集内划分CD与非CD亚组.比较训练集内亚组间临床资料及多模态CT[平扫CT、CT血管成像(CTA)及CT灌注成像(CTP)]参数,基于差异有统计学意义者构建多因素logistic回归模型,筛选CD独立影响因素,并以受试者工作特征曲线下面积(AUC)评估模型预测效能。结果训练集内CD亚组饮酒史占比、Alberta卒中项目早期CT评分(ASPECTS)及缺血半暗带脑血容量(CBV)比值均低于,而冠心病占比、美国国立卫生研究院卒中量表(NIHSS)评分、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)及梗死核心体积均高于非CD亚组(P均<0.05)。高NLR和梗死核心体积大为AIS合并T2DM患者CD的独立危险因素,高ASPECTS和高缺血半暗带CBV比值为其独立保护因素(P均<0.05)。所获模型预测训练集和验证集AIS合并T2DM患者CD的AUC分别为0.998和0.993。结论多模态CT联合临床指标预测AIS合并T2DM患者CD效能良好。
Objective To observe the value of multimodal CT combined with clinical indexes for predicting cognitive disorder(CD)in acute ischemic stroke(AIS)patients complicated with type 2 diabetes mellitus(T2DM).Methods A total of 346 cases of AIS complicated with T2DM were retrospectively enrolled and randomly divided into training(n=242)and validation(n=104)sets at a ratio of 7∶3,whom were also categorized into CD and non-CD subgroups based on Montreal cognitive assessment(MoCA)scale scores 6 months after discharge.Multimodal CT parameters,including non-contrast CT,CT angiography(CTA)and CT perfusion(CTP),as well as clinical data were compared between subgroups in training set.A multivariate logistic regression model was constructed based on indexes being significantly different between subgroups to identify independent impact factors of CD,and the performance of the model was evaluated using the area under the receiver operating characteristic curve(AUC).Results In training set,the proportion of alcohol drinking history,Alberta stroke program early CT scores(ASPECTS),ischemic penumbra cerebral blood volume(CBV)ratio in CD subgroup were all lower,while the proportion of coronary heart disease,National Institutes of Health stroke scale(NIHSS)scores,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR)and infarct core volume in CD subgroup were all higher than those in non-CD subgroup(all P<0.05).Both elevated NLR and larger infarct core volume were independent risk factors,while both higher ASPECTS and higher ischemic penumbra CBV ratio were independent protective factors of CD(all P<0.05).AUC of the model achieved 0.998 and 0.993 in training and validation sets,respectively.Conclusion Multimodal CT combined with clinical indexes demonstrated good performance for predicting CD in patients with AIS and T2DM.
作者
于雅巍
徐永平
杨冬生
国志萌
刘星
唐慧
YU Yawei;XU Yongping;YANG Dongsheng;GUO Zhimeng;LIU Xing;TANG Hui(Medical Imaging Center,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China;Department of Neurology,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China;Department of Pathology,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China)
出处
《中国医学影像技术》
北大核心
2026年第2期171-176,共6页
Chinese Journal of Medical Imaging Technology
基金
河北省医学科学研究课题计划(20240600)。
关键词
缺血性卒中
糖尿病
2型
认知障碍
体层摄影术
X线计算机
ischemic stroke
diabetes mellitus,type 2
cognition disorders
tomography,X-ray computed
