本文選題：腦梗死　切入點：前循環(huán)　出處：《浙江大學》2014年碩士論文　論文類型：學位論文

【摘要】：研究目的： 本研究分為兩塊,分別探討磁共振液體衰減反轉(zhuǎn)恢復序列(fluid-attenuated inversion recovery imaging, FLAIR)病灶實質(zhì)高信號(FLAIR Lesional Parenchymal Hyperintensity, FPH)以及血管高信號(FLAIR vascular hyperintensity, FVH)與靜脈溶栓的關(guān)系。 研究方法： 回顧性分析本科2009年5月至2013年12月連續(xù)收集的具有溶栓前和溶栓后24小時多模式磁共振的缺血性腦卒中靜脈溶栓患者的臨床和影像資料。選取前循環(huán)梗死的病例,評估梗死病灶是否存在高信號表現(xiàn)(FPH)以及大腦中動脈遠端供血區(qū)域FVH的程度,并分析FPH、FVH與靜脈溶栓后再灌注、出血轉(zhuǎn)化以及功能預后的關(guān)系,溶栓后3月隨訪改良Rankin評分,2分定義為預后不良。 研究結(jié)果： 共納入95例患者分析,39例(41.0%)FPH陽性,與FPH陰性者相比,FPH陽性者年齡小(64.0±11.8vs.72.2±11.5；P=0.001)、起病-影像檢查時間長(onset to imaging time, OIT)(217.6＋78.6vs.180.0±63.5; P=0.012)高血壓病史少見(50.9%vs.80.4%；P=0.023),其獨立影響因素是OIT(OR=1.011,95%CI：1.004—1.018；P=0.003)、年齡(OR=0.926,95%CI：0.887—0.968；P=0.001)和既往卒中史(OR=4.412,95%CI:1.188—16.379；P=0.027)。FPH陽性不增加溶栓后出血轉(zhuǎn)化的風險(43.5%vs.34.6%； P=0.434),意味著較低的溶栓后再通率(OR=0.203,95%CI：0.043—0.961；P=0.044),是3月預后不良的獨立危險因素(OR=5.461,95%CI:1.346-22.151；P=0.017)。57例(60.0%)存在FVH,較FVH陰性者基線NIHSS高(7.2±4.5vs.12.1+6.1；P0.001)、彌散成像(diffusion weighted imaging,DWI)病灶更大(2vs.5.5；P=0.002)、灌注成像(perfusion weighted imaging,PWI)低灌注區(qū)更大(3vs.73.5；P0.001)、近端大血管閉塞者多見(10.5%vs.82.5%；P0.001),其中后者為FVH陽性的獨立影響因素(OR=48.712,95%CI：7.772-305.326; P0.001); FVH日性者出血轉(zhuǎn)化率更高(80.8%vs.52.2%；P=0.011),但不構(gòu)成出血轉(zhuǎn)化的獨立影響因素(OR=1.079,95%CI：0.278—4.181；P=0.913)；FVH陽性基線目標不匹配更大(OR=8.557,95%CI：2.592—28.245；P0.001),但不增加早期再灌率(OR=0.441,95%CI:0.089—2.179；P=0.315),是3月預后不良的獨立危險因素(OR=3.826,95%CI:1.125-13.257；P=0.032)；早期再灌是所有溶栓患者3月預后良好的獨立預測因素(OR=5.196,95%CI：1.266-21.322；P=0.022),對FVH陽性者預后改善尤其顯著(OR=14.908,95%CI：2.100-105.852；P=0.007)。研究結(jié)論： FPH的存在與缺血事件持續(xù)的時間有關(guān),其存在降低溶栓后再通率；FVH的存在則與大血管嚴重狹窄有關(guān),基線梗死更嚴重,目標不匹配區(qū)更大；二者均不增加溶栓出血轉(zhuǎn)化風險,均影響靜脈溶栓遠期預后,但早期再灌注可顯著改善FVH陽性者的溶栓預后。相對于物理時鐘,FPH可能是更準確的組織時鐘；而FVH作為側(cè)枝血供,可能為再灌注策略選擇提供一定的信息。
[Abstract]:Objectives of the study:. The purpose of this study was to investigate the relationship between fluid-attenuated inversion recovery imaging (flair) and vascular hyperintense vascular (FVH) in patients with fluid-attenuated inversion recovery imaging (flair). Research methods:. The clinical and imaging data of ischemic stroke patients with multimode magnetic resonance imaging before and after thrombolysis were analyzed retrospectively from May 2009 to December 2013. The patients with anterior circulation infarction were selected. To evaluate the presence of hyperintense FVH in the infarct focus and the extent of FVH in the distal middle cerebral artery (MCAA), and to analyze the relationship between FVH and reperfusion, hemorrhage transformation and functional prognosis after thrombolytic therapy. The modified Rankin score was followed up on March after thrombolysis and 2 points were defined as poor prognosis. Results of the study:. A total of 95 patients were included in this study. 39 patients with FPH were found to be 41.0 positive. The age of patients with positive FPH was 64.0 鹵11.8vs.72.2 鹵11.5p 0.001g, the onset time was longer than that of imaging time, OIT)(217.6+78.6vs.180.0 鹵63.5; P0.012) the patient had a rare history of hypertension. The independent influential factors were: OITOR1.01195CIW 1.004-1.018P0.003, age OR260.995 CIW 0.887-0.368 P0.001) and stroke history OR4.412951.188-16.379P0.027P0.27. the independent influential factors were: OITOR1.01195CIw 1.004-1.01818P0.003, age OR260.995CI0 0.887-0.368 P0.001) and stroke history OR4.41295951.188-16.379P0.027Ph + no increase in CI. The risk is 43.5vs.34.6. P0. 3434, which means that the lower rate of recanalization after thrombolysis is OR0.203 / 95CIV: 0.043-0.961P0.0444.It is an independent risk factor for poor prognosis on March, OR5.461C95CI: 1.346-22.151P0.017.57) FVHs, 7.2 鹵4.5vs.12.1 6.1P0.001N, 2vs.55.5P0. 00PPWT, 2vs.55.5P0. 00PPW2, perfusion imaging weighted imaging / weighted imaging / weighted imaging / imaging / imaging / imaging / DWI / P / P / P ~ (0.001) / P ~ (0.001) / P ~ (0.001) / P ~ (0.001) / P ~ (0.0011), P = = =. The larger note area is 3vs.73.5% P0.001T, and 10.5vs.82.5% P0.001g is more common in the patients with proximal macrovascular occlusion. The latter is the independent influencing factor of FVH positivity, OR48.712C95CIV7.772-305.326; P0.001; FVH daily haemorrhage conversion rate is higher than 80.8vs.52.2g / P0.01; but the independent influencing factor does not constitute the independent factor of OR1.079-95CI0.278-4.181Pt0. 0278-4. 181Pt0. 0278-4. 181Pt0. 9131Pt0 mismatch the FVH positive baseline target. The larger OR8.55795 CIV 2.592-28.245P0.001, but without increasing the early reperfusion rate, OR0.441-95CI0.089-2.179P0.315, is an independent risk factor for poor prognosis on March, OR3.82695CII 1.125-13.257P0.032; early reperfusion is an independent predictor of a good prognosis for all thrombolytic patients on March; an independent predictor of the prognosis of all patients with thrombolytic thrombolysis is 5.19695CI1.266-322P0.022222.The prognosis of FVH positive patients is especially improved by 14.90895CI2.100-105.852P0.072. Conclusion:. The presence of FPH was related to the duration of ischemic events. The presence of FPH was associated with severe stenosis of large vessels, more severe baseline infarction and larger target mismatch area, and neither of them increased the risk of thrombolytic hemorrhage. Early reperfusion could significantly improve the prognosis of thrombolytic therapy in patients with FVH positive. FVH may be a more accurate tissue clock than physical clock. It may provide some information for the choice of reperfusion strategy.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3

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