本文關(guān)鍵詞： FLAIR高信號(hào)血管征 大腦中動(dòng)脈閉塞 側(cè)支循環(huán) 預(yù)后　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究以大腦中動(dòng)脈(middle cerebral artery,MCA)M1段急性閉塞的患者為研究對象,探討FLAIR血管高信號(hào)(FLAIR vascular hyperintensity,FVH)評(píng)價(jià)側(cè)支循環(huán)的準(zhǔn)確性;研究影響FVH的相關(guān)因素;評(píng)估FVH能否作為判斷臨床病情嚴(yán)重程度及短期預(yù)后的指標(biāo)。對象與方法:我們回顧性分析了從2011年1月——2016年12月期間于大連醫(yī)科大學(xué)附屬第二醫(yī)院神經(jīng)內(nèi)科住院的大腦中動(dòng)脈M1段急性閉塞的患者,最后有53名患者被納入分析,其中男性29例,女性24例,平均年齡60.03歲(30-84歲)。入院24小時(shí)內(nèi)磁共振檢查明確腦梗死診斷,入院72小時(shí)內(nèi)完成全腦血管造影檢查明確其責(zé)任病變?yōu)榇竽X中動(dòng)脈M1段閉塞。用阿爾伯塔腦卒中計(jì)劃早期診斷評(píng)分(Alberta Stroke Program Early CT Score,ASPECT)評(píng)估FLAIR成像上的FVH,用美國介入和治療神經(jīng)放射學(xué)學(xué)會(huì)、介入放射學(xué)學(xué)會(huì)側(cè)支循環(huán)評(píng)分(American Society of Interventional and Therapeutic Neuroradiology、Society of Interventional Radiology ASITN/SIR)來評(píng)估側(cè)支循環(huán)。依據(jù)FVH-ASPECT評(píng)分對FVH進(jìn)行評(píng)價(jià)并分為低表達(dá)(0-4分)、中表達(dá)(5-8分)以及高表達(dá)(9-12分)三組,比較各組間的臨床資料。采用ASITN/SIR評(píng)分對大腦中動(dòng)脈梗死區(qū)域內(nèi)的側(cè)支循環(huán)進(jìn)行評(píng)估。將數(shù)據(jù)分為兩組,代償充分組(3-4)和代償不充分組(0-2)。同樣比較各組間的臨床資料。用等級(jí)回歸對FVH的影響因素進(jìn)行分析。用ROC曲線分析FVH對側(cè)支循環(huán)的診斷價(jià)值。用Mann-Whitney U檢驗(yàn)對兩組的初始NIHSS評(píng)分和7天NIHSS評(píng)分進(jìn)行分析。結(jié)果:總共納入符合標(biāo)準(zhǔn)的患者53例,其中遠(yuǎn)端FVH陽性46例(87%),男性26例(57%),女性20例(43%)。FVH與吸煙、冠心病、糖尿病及入院時(shí)的血壓相關(guān)。側(cè)支循環(huán)與吸煙及血壓相關(guān)。FVH危險(xiǎn)因素的多因素回歸分析顯示,在排除其它因素的情況下,吸煙、冠心病對FVH有顯著影響,吸煙患者的FVH分級(jí)更高,合并冠心病的患者FVH分級(jí)更低。ROC曲線下面積為0.893(95%CI:0.808-0.977),說明FVH對側(cè)支循環(huán)的診斷價(jià)值較高。當(dāng)FVH為7.5時(shí),對側(cè)支循環(huán)的診斷價(jià)值最高,靈敏度為0.694,特異度為0.938。FVH各組的初始NIHSS和7天NIHSS差異均有統(tǒng)計(jì)學(xué)意義(P0.05),FVH分類的級(jí)別越高,初始NIHSS評(píng)分和7天NIHSS評(píng)分越低。結(jié)論:(1)本研究結(jié)果顯示對于大腦中動(dòng)脈M1段閉塞的患者,FVH陽性率為87%(46/53),且與軟腦膜側(cè)支循環(huán)顯著相關(guān),對側(cè)支循環(huán)的診斷率達(dá)到96%(46/48)。(2)入院時(shí)的收縮壓及舒張壓與側(cè)支循環(huán)以及FVH相關(guān)。(3)FVH-ASPECT評(píng)分能夠準(zhǔn)確評(píng)估側(cè)支循環(huán)(ROC曲線下面積為0.893,95%CI:0.808-0.977),靈敏度為0.694,特異度為0.938。建議臨床上可用FVH代替磁共振灌注成像來作為急性期側(cè)支循環(huán)的評(píng)估。(4)FVH-ASPECT評(píng)分與腦梗死患者臨床預(yù)后相關(guān),FVH-ASPECT評(píng)分高的患者,初始及7天后的NIHSS評(píng)分均低于評(píng)分較低的。
[Abstract]:Objective: to investigate the accuracy of evaluation of collateral circulation in patients with acute occlusion of middle middle cerebral artery of middle cerebral artery (MCA-MCA-M1) with high signal FLAIR vascular hyperintensity, and to study the related factors affecting FVH. Objective and methods: from January 2011 to December 2016, we retrospectively analyzed the hospitalization in the Department of Neurology, second affiliated Hospital, Dalian Medical University, from January 2011 to December 2016. In patients with acute occlusion of M1 segment of the middle cerebral artery, Finally, 53 patients were included in the analysis, including 29 males and 24 females, with an average age of 60.03 years or 30-84 years. MRI was used to diagnose cerebral infarction within 24 hours of admission. Complete all cerebral angiography within 72 hours of admission to determine whether the responsible lesion is M1 segment occlusion of the middle cerebral artery. The Alberta Stroke Program Early CT ScoreASPECT was used to evaluate the FVHs on FLAIR imaging. Society of Therapeutic Neuroradiology, American Society of Interventional and Therapeutic collateral circulation was evaluated by American Society of Interventional Radiology ASITN / SIRs. FVH was evaluated according to FVH-ASPECT score and divided into three groups: low expression 0-4, middle expression 5-8) and high expression 9-12). ASITN/SIR score was used to evaluate the collateral circulation in the infarcted area of the middle cerebral artery. The data were divided into two groups. The clinical data of each group were also compared. The influencing factors of FVH were analyzed by grade regression. The diagnostic value of contralateral collateral circulation of FVH was analyzed by ROC curve. The diagnostic value of Mann-Whitney U test was used for the two groups. The initial NIHSS score and 7 day NIHSS score were analyzed. Results: a total of 53 eligible patients were included. 46 cases of distal FVH were positive, 26 cases were male, 20 cases were female, 20 cases were associated with smoking, coronary heart disease, diabetes mellitus and blood pressure on admission. The multiple regression analysis of collateral circulation and risk factors of smoking and blood pressure. When other factors were excluded, smoking and coronary heart disease had significant effects on FVH. The FVH grade of smoking patients was higher than that of controls. In patients with coronary heart disease, the area under the curve of lower .ROC was 0.89395% CI: 0.808-0.977, which indicated that the diagnostic value of contralateral collateral circulation of FVH was higher when FVH was 7.5.The diagnostic value of contralateral collateral circulation was the highest when FVH was 7.5. The sensitivity was 0.694, the specificity was 0.938. The difference of initial NIHSS and 7-day NIHSS was statistically significant. Conclusion the results of this study showed that the positive rate of NIHSS in patients with M1 segment occlusion of middle cerebral artery was 8746 / 53, and was significantly correlated with collateral circulation of pia. The diagnostic rate of contralateral collateral circulation was 96 / 46 / 48. 2) systolic and diastolic blood pressure and collateral circulation and FVH related FVH-ASPECT score could accurately evaluate the area under the ROC curve of collateral circulation was 0.808-0.9777.The sensitivity was 0.694, and the specificity was 0.938. Using FVH instead of magnetic resonance perfusion imaging as an assessment of collateral circulation in acute phase, the FVH-ASPECT score was correlated with the clinical prognosis of patients with cerebral infarction and the patients with high FVH-ASPECT score. NIHSS scores were lower at the beginning and 7 days later than those with lower scores.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

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