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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): 377-383    DOI: 10.3785/j.issn.1008-9292.2017.08.06
缺血性卒中专题     
基于CT灌注成像的侧支评分预测急性前循环大血管闭塞患者动脉取栓治疗预后的价值
王庆松1,2, 张圣1, 张美霞1, 陈智才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. 浙江省嵊州市人民医院神经内科, 浙江 嵊州 312400
Collateral score based on CT perfusion can predict the prognosis of patients with anterior circulation ischemic stroke after thrombectomy
WANG Qingsong1,2, ZHANG Sheng1, ZHANG Meixia1, CHEN Zhicai1, LOU Min1
1. Department of Neurology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
2. Department of Neurology, Shengzhou People's Hospital, Shengzhou 312400, China
 全文: PDF(3728 KB)  
摘要：

目的：评估基于CT灌注成像的软脑膜侧支评价方法（CTP-CS）在预测急性前循环大血管闭塞患者动脉取栓治疗预后中的价值。方法：回顾性分析2013年10月至2016年10月浙江大学医学院附属第二医院急性前循环大血管闭塞动脉取栓患者的临床及影像学资料。采用CTP-CS和基于数字减影血管造影的侧支评分（DSA-CS）对侧支进行评分，DSA-CS或CTP-CS评分3~4分定义为侧支良好。预后优定义为术后3个月时改良Rankin量表（mRS）为2分及以下。采用二元logistic回归法分析侧支循环与患者预后的关系并用受试者工作特征（ROC）曲线评价DSA-CS和CTP-CS在预测患者预后中的价值。结果：共纳入40例患者，其中获得血管再通33例（82.5%），临床预后优16例（40.0%）。与预后不优的患者比较，预后优的患者侧支评分更高（均P<0.05），侧支良好比例更高（均P<0.01）。二元logistic回归分析提示，侧支评分是预后优的独立预测因素（CTP-CS：OR=48.404，95%CI：1.373~1706.585，P<0.05；DSA-CS：OR=34.651，95%CI：1.147~1047.018，P<0.05）。一致性分析提示，CTP-CS和DSA-CS两种评分间的一致性良好（κ=0.697，P<0.01）。ROC曲线分析结果显示，CTP-CS预测患者临床预后的能力与DSA-CS相当（均AUC=0.726，95%CI：0.559~0.893，P<0.05）。结论：CTP-CS评分能独立预测急性前循环大血管闭塞患者动脉取栓治疗的预后。
关键词： 急性病;  脑缺血/放射摄影术;  体层摄影术;  X线计算机/方法;  脑缺血/治疗;  卒中/治疗;  血栓溶解疗法/方法;  侧支循环;  预后    
Abstract:

Objective:To evaluate the value of collateral score based on CT perfusion (CTP-CS) in predicting the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy. Methods:Clinical data of acute ischemic stroke patients with anterior artery occlusion undergoing endovascular treatment in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and October 2016 were retrospectively reviewed. Collateral scores were assessed based on CTP and digital subtraction angiography (DSA) images, respectively. And DSA-CS or CTP-CS 3-4 was defined as good collateral vessels. Good clinical outcome was defined as a modified Rankin Scale (mRS) ≤ 2 at 3 months after stroke. The binary logistic regression model was used to analyze the correlation between the collateral score and clinical outcome, and the receiver operating characteristic (ROC) curve was used to analyze the value of DSA-CS and CTP-CS in predicting the clinical outcome. Results:Among 40 patients, 33 (82.5%) acquired recanalization and 16 (40.0%) got good outcome. Compared with poor outcome group, the collateral score (all P<0.05) and the rate of good collateral vessels were higher in good outcome group (all P<0.01). After adjust baseline National Institute of Health Stroke Scale (NIHSS) and onset to recanalization time (ORT), good collateral vessels were independent factor of good outcome (CTP-CS:OR=48.404, 95% CI:1.373-1706.585, P<0.05; DSA-CS:OR=34.651, 95% CI:1.147-1047.018, P<0.05). Collateral scores based on CTP and DSA had good consistency (κ=0.697, P<0.01), and ROC curve showed that the predictive value of CTP-CS and DSA-CS were comparable (both AUC=0.726, 95%CI:0.559-0.893, P<0.05). Conclusion:CTP-CS can predict the clinical outcome of patients with anterior circulation ischemic stroke after thrombectomy.
Key words: Acute disease    Brain ischemia/radiography    Tomography, X-ray computed    Brain ischemia/therapy    Stroke/therapy    Thrombolytic therapy/methods    Collateral circulation    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: 王庆松(1979-),男,硕士研究生,副主任医师,主要从事神经病学研究;E-mail:drwangqs@163.com;http://orcid.org/0000-0002-2051-0556
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引用本文:

王庆松 等. 基于CT灌注成像的侧支评分预测急性前循环大血管闭塞患者动脉取栓治疗预后的价值[J]. 浙江大学学报（医学版）, 2017, 46(4): 377-383.

WANG Qingsong, ZHANG Sheng, ZHANG Meixia, CHEN Zhicai, LOU Min. Collateral score based on CT perfusion can predict the prognosis of patients with anterior circulation ischemic stroke after thrombectomy. Journal of ZheJiang University(Medical Science), 2017, 46(4): 377-383.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2017.08.06    或    http://www.zjujournals.com/xueshu/med/CN/Y2017/V46/I4/377

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