中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
4期
342-345
,共4页
田超%杨天昊%解中福%崔世民
田超%楊天昊%解中福%崔世民
전초%양천호%해중복%최세민
血液灌注%毛细血管通透性%脑梗死%出血
血液灌註%毛細血管通透性%腦梗死%齣血
혈액관주%모세혈관통투성%뇌경사%출혈
Hemoperfusion%Capillary permeability%Brain infarction%Hemorrhage
目的 探讨采用灌注CT技术的微血管通透性(PS)测量值预测老年人急性脑梗死出血性转化(HT)的可能性. 方法 回顾分析接受静脉溶栓治疗的大脑中动脉供血区急性脑梗死患者52例,将患者分为HT组和对照组,HT组进一步分为出血性梗死组和脑血肿形成组.回顾性分析比较各组间发病6h内灌注CT各项参数测量结果和CT血管造影源图像(CTA-SI)中Alberta卒中计划早期CT评分(ASPECTS)的统计学差异. 结果 52例患者中22例发生HT,其中出血性梗死14例,脑血肿形成8例.HT组患侧和对照组患侧的脑血流量及脑血流量值较健侧下降,PS值较健侧升高(均P＜0.05).HT组患侧PS值高于对照组患侧(P＜0.01);而HT组患侧脑血流量及脑血流量值与对照组患侧的差异无统计学意义.PS值特异性曲线下面积为0.968,当PS≥5.77 ml·min-1· 100 g-1时,其预测HT的敏感度为95.5％,特异度为86.7％.HT组的ASPECTS低于对照组(Z=-5.533,P＜0.01),出血性梗死组的ASPECTS高于脑血肿形成组(Z=-3.771,P＜0.01),出血性梗死组与脑血肿形成组患侧各项灌注参数间差异无统计学意义. 结论 PS值显著升高可以作为预测HT风险、指导溶栓治疗的参考依据.
目的 探討採用灌註CT技術的微血管通透性(PS)測量值預測老年人急性腦梗死齣血性轉化(HT)的可能性. 方法 迴顧分析接受靜脈溶栓治療的大腦中動脈供血區急性腦梗死患者52例,將患者分為HT組和對照組,HT組進一步分為齣血性梗死組和腦血腫形成組.迴顧性分析比較各組間髮病6h內灌註CT各項參數測量結果和CT血管造影源圖像(CTA-SI)中Alberta卒中計劃早期CT評分(ASPECTS)的統計學差異. 結果 52例患者中22例髮生HT,其中齣血性梗死14例,腦血腫形成8例.HT組患側和對照組患側的腦血流量及腦血流量值較健側下降,PS值較健側升高(均P＜0.05).HT組患側PS值高于對照組患側(P＜0.01);而HT組患側腦血流量及腦血流量值與對照組患側的差異無統計學意義.PS值特異性麯線下麵積為0.968,噹PS≥5.77 ml·min-1· 100 g-1時,其預測HT的敏感度為95.5％,特異度為86.7％.HT組的ASPECTS低于對照組(Z=-5.533,P＜0.01),齣血性梗死組的ASPECTS高于腦血腫形成組(Z=-3.771,P＜0.01),齣血性梗死組與腦血腫形成組患側各項灌註參數間差異無統計學意義. 結論 PS值顯著升高可以作為預測HT風險、指導溶栓治療的參攷依據.
목적 탐토채용관주CT기술적미혈관통투성(PS)측량치예측노년인급성뇌경사출혈성전화(HT)적가능성. 방법 회고분석접수정맥용전치료적대뇌중동맥공혈구급성뇌경사환자52례,장환자분위HT조화대조조,HT조진일보분위출혈성경사조화뇌혈종형성조.회고성분석비교각조간발병6h내관주CT각항삼수측량결과화CT혈관조영원도상(CTA-SI)중Alberta졸중계화조기CT평분(ASPECTS)적통계학차이. 결과 52례환자중22례발생HT,기중출혈성경사14례,뇌혈종형성8례.HT조환측화대조조환측적뇌혈류량급뇌혈류량치교건측하강,PS치교건측승고(균P＜0.05).HT조환측PS치고우대조조환측(P＜0.01);이HT조환측뇌혈류량급뇌혈류량치여대조조환측적차이무통계학의의.PS치특이성곡선하면적위0.968,당PS≥5.77 ml·min-1· 100 g-1시,기예측HT적민감도위95.5％,특이도위86.7％.HT조적ASPECTS저우대조조(Z=-5.533,P＜0.01),출혈성경사조적ASPECTS고우뇌혈종형성조(Z=-3.771,P＜0.01),출혈성경사조여뇌혈종형성조환측각항관주삼수간차이무통계학의의. 결론 PS치현저승고가이작위예측HT풍험、지도용전치료적삼고의거.
Objective To study the possibility of microvascular permeability (PS) value derived from perfusion CT (PCT) in predicting hemorrhagic transformation (HT) in acute cerebral infarction in elderly patients.Methods 52 consecutive patients with middle cerebral artery acute ischemic stroke who received thrombolytic therapy were divided into HT group and control group,and patients in HT group were further divided into hemorrhagic infarction (HI) group and parenchymal hematoma (PH) group.PCT data and Alberta stroke program early CT scores (ASPECTS) from CT angiography source images (CTA-SI) achieved within 6 hours after symptom onset of each group was retrospectively analyzed and statistically processed.Results In 52 patients,there were 22 cases developed HT,14 cases with HI,8 cases with PH.Cerebral blood flow (CBF) and cerebral blood volume (CBV) values were decreased and permeability surface area product (PS) was increased in ipsilateral in HT group and control group as compared with the contralateral (all P＜0.05).PS value in ipsilateral was significantly higher in HT group than in control group (P＜0.01),but CBF and CBV values in affected side showed no significant difference between the HT group and control group.The area under the receiver operator characteristic (ROC) curve of PS Az value was 0.968.When PS ≥5.77 ml · min-1 · 100 g-1,the sensitivity and specificity of predicting HT were 95.5％ and 86.7％ respectively.The ASPECTS was lower in HT group than in the control group (P＜0.01),and ASPECTS was higher in HI group than in PH group (P＜0.01).The differences in PCT results in affected side between the HI group and PH group was not significant.Conclusions The significantly increased PS value can be a reference in predicting HT risk and guiding thrombolytic therapy.
