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浙江大学学报（医学版）
浙江大学学报（医学版）  2017, Vol. 46 Issue (4): 371-376    DOI: 10.3785/j.issn.1008-9292.2017.08.05
缺血性卒中专题     
动态CT血管造影评估急性基底动脉闭塞患者侧支血流与再灌注治疗预后的关系
赖针珍1,2, 张圣1, 钟根龙1, 张晓程1, 陈清梦1, 楼敏1
1. 浙江大学医学院附属第二医院神经内科, 浙江 杭州 310009;
2. 浙江省天台县人民医院神经内科, 浙江 天台 317200
Relationship between dynamic CT angiography-based collateral flow evaluation and outcome of patients with stroke induced by acute basilar artery occlusion
LAI Zhenzhen1,2, ZHANG Sheng1, ZHONG Genlong1, ZHANG Xiaocheng1, CHEN Qingmeng1, LOU Min1
1. Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
2. Department of Neurology, Tiantai People's Hospital of Zhejiang Province, Tiantai 317200, China
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摘要：

目的：研究动态CT血管造影对急性基底动脉闭塞所致缺血性卒中患者侧支血流状态评估以及预测再灌注治疗后结局的价值。方法：回顾性分析2012年1月至2016年8月在浙江大学医学院附属第二医院接受再灌注治疗的45例急性基底动脉闭塞所致缺血性卒中患者的临床资料。采用单因素和二元logistic回归模型分析患者预后的独立预测因素，并采用受试者工作特征（ROC）曲线确定预测患者预后的后循环侧支评分（PC-CS）的最佳阈值。结果：二元logistic回归分析提示，基线美国国立卫生研究院卒中量表（NIHSS）评分（OR=0.886，95%CI：0.802~0.979，P<0.05）和PC-CS（OR=1.962，95%CI：1.026~3.752，P<0.05）是患者预后的独立预测因素，且PC-CS 4.5分是预测患者预后的最佳阈值（AUC=0.837，敏感度为68.2%，特异度为87.0%）。结论：基于CT灌注成像重建的动态CT血管造影可用于评估后循环侧支血流状态，并能预测急性基底动脉闭塞所致缺血性卒中患者再灌注治疗后的临床结局。
关键词： 基底动脉;  侧支循环;  再灌注;  动脉闭塞性疾病/药物疗法;  卒中/药物疗法;  血流动力学;  血管造影术;  数字减影;  体层摄影术;  X线计算机/方法;  血栓溶解疗法/方法;  预后    
Abstract:

Objective:To evaluate the collateral flow in patients with ischemic stroke due to acute basilar artery occlusion by dynamic CT angiography and to predict the outcome after reperfusion therapy. Methods:Forty-five patients with stroke due to acute basilar artery occlusion undergoing reperfusion treatment in the Second Affiliated Hospital of Zhejiang University School of Medicine during January 2012 and August 2016 were retrospectively reviewed. Univariate and binary logistic regression model were used to identify the independent predictors of patient's outcome, and the receiver operating characteristic (ROC) curve was used to determine the optimal threshold of the posterior circulation collateral score (PC-CS) in predicting the prognosis of the patients. Results:Binary logistic regression analysis indicated that the baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=0.886, 95% CI:0.802-0.979, P<0.05) and PC-CS (OR=1.962, 95%CI:1.026-3.752, P<0.05) were independent predictors of patient's outcome, and PC-CS 4.5 was the optimal threshold (AUC:0.837, sensitivity of 68.2%, specificity of 87.0%). Conclusion:Dynamic CT angiography based on CT perfusion imaging can be used to evaluate collaterals in posterior circulation, and to predict clinical outcome after reperfusion therapy in patients with acute basilar artery occlusion.
Key words: Basilar artery    Collateral circulation    Reperfusion    Arterial occlusive diseases/drug therapy    Stroke/drug therapy    Hemodynamics    Angiography, digital subtraction    Tomography, X-ray computed/methods    Thrombolytic therapy/methods    Prognosis
收稿日期: 2017-02-10 出版日期: 2017-08-25
CLC:  R743.3  
基金资助:

国家自然科学基金（81471170，81622017）
通讯作者: 楼敏(1976-),女,博士,主任医师,教授,博士生导师,主要从事神经病学研究;E-mail:lm99@zju.edu.cn;http://orcid.org/0000-0002-6627-064X     E-mail: lm99@zju.edu.cn
作者简介: 赖针珍(1984-),女,硕士研究生,主治医师,主要从事神经病学研究;E-mail:24909698@qq.com;http://orcid.org/0000-0001-5080-6107
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引用本文:

赖针珍 等. 动态CT血管造影评估急性基底动脉闭塞患者侧支血流与再灌注治疗预后的关系[J]. 浙江大学学报（医学版）, 2017, 46(4): 371-376.

LAI Zhenzhen, ZHANG Sheng, ZHONG Genlong, ZHANG Xiaocheng, CHEN Qingmeng, LOU Min. Relationship between dynamic CT angiography-based collateral flow evaluation and outcome of patients with stroke induced by acute basilar artery occlusion. Journal of ZheJiang University(Medical Science), 2017, 46(4): 371-376.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2017.08.05    或    http://www.zjujournals.com/xueshu/med/CN/Y2017/V46/I4/371

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