本文關鍵詞： FLAIR高信號血管征 大腦中動脈閉塞 側支循環(huán) 預后　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本研究以大腦中動脈(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(FLAIR vascular hyperintensity,FVH)評價側支循環(huán)的準確性;研究影響FVH的相關因素;評估FVH能否作為判斷臨床病情嚴重程度及短期預后的指標。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)科大學附屬第二醫(yī)院神經(jīng)內科住院的大腦中動脈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小時內磁共振檢查明確腦梗死診斷,入院72小時內完成全腦血管造影檢查明確其責任病變?yōu)榇竽X中動脈M1段閉塞。用阿爾伯塔腦卒中計劃早期診斷評分(Alberta Stroke Program Early CT Score,ASPECT)評估FLAIR成像上的FVH,用美國介入和治療神經(jīng)放射學學會、介入放射學學會側支循環(huán)評分(American Society of Interventional and Therapeutic Neuroradiology、Society of Interventional Radiology ASITN/SIR)來評估側支循環(huán)。依據(jù)FVH-ASPECT評分對FVH進行評價并分為低表達(0-4分)、中表達(5-8分)以及高表達(9-12分)三組,比較各組間的臨床資料。采用ASITN/SIR評分對大腦中動脈梗死區(qū)域內的側支循環(huán)進行評估。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。用等級回歸對FVH的影響因素進行分析。用ROC曲線分析FVH對側支循環(huán)的診斷價值。用Mann-Whitney U檢驗對兩組的初始NIHSS評分和7天NIHSS評分進行分析。結果:總共納入符合標準的患者53例,其中遠端FVH陽性46例(87%),男性26例(57%),女性20例(43%)。FVH與吸煙、冠心病、糖尿病及入院時的血壓相關。側支循環(huán)與吸煙及血壓相關。FVH危險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分級更高,合并冠心病的患者FVH分級更低。ROC曲線下面積為0.893(95%CI:0.808-0.977),說明FVH對側支循環(huán)的診斷價值較高。當FVH為7.5時,對側支循環(huán)的診斷價值最高,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)計學意義(P0.05),FVH分類的級別越高,初始NIHSS評分和7天NIHSS評分越低。結論:(1)本研究結果顯示對于大腦中動脈M1段閉塞的患者,FVH陽性率為87%(46/53),且與軟腦膜側支循環(huán)顯著相關,對側支循環(huán)的診斷率達到96%(46/48)。(2)入院時的收縮壓及舒張壓與側支循環(huán)以及FVH相關。(3)FVH-ASPECT評分能夠準確評估側支循環(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支循環(huán)的評估。(4)FVH-ASPECT評分與腦梗死患者臨床預后相關,FVH-ASPECT評分高的患者,初始及7天后的NIHSS評分均低于評分較低的。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3

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