CAJ | 학술논문

目的评价弥散加权成像-Alberta卒中项目早期CT评分(DWI-ASPECTS)用于预测缺血性卒中患者溶栓后症状性颅内出血的可靠性.方法回顾性分析内蒙古自治区包头市中心医院2010-2013年连续入院的急性前循环缺血性卒中患者53例,均在入院时完成头颅磁共振平扫及弥散成像,并于发病4.5h内给予阿替普酶溶栓治疗(0.6 mg/kg).记录患者年龄、溶栓前NIHSS评分、发病到开始溶栓时间等信息.DWI-ASPECTS评分为弥散图像前循环被标注的10个区域,总分10分,每累及1个区域减去1分.将患者分为3组:0～5分16例,6～7分17例,8～10分20例.症状性颅内出血为溶栓治疗后36 h经CT或磁共振证实的颅内出血,同时NIHSS评分升高4分以上.结果 53例患者中发生症状性颅内出血10例(18.8％),DWI-ASPECTS评分分别是0～5分6例(37.5％),6～7分3例(17.6％),8～10分1例(5.0％).与6～7分组、8～10分组比较,0～5分组患者出现症状性颅内出血的风险明显升高(x2 =7.861,P=0.005).DWI-ASPECTS评分与症状性颅内出血具有良好的相关性,Logistic回归模型分析显示:在矫正年龄、发病到开始溶栓时间等因素后,DWI-ASPECTS评分是症状性颅内出血的独立预测因素.结论 DWI-ASPECTS能预测缺血性卒中溶栓后症状性颅内出血的风险,可作为溶栓前快速评价症状性颅内出血风险的方法.
목적 평개미산가권성상-Alberta졸중항목조기CT평분(DWI-ASPECTS)용우예측결혈성졸중환자용전후증상성로내출혈적가고성.방법 회고성분석내몽고자치구포두시중심의원2010-2013년련속입원적급성전순배결혈성졸중환자53례,균재입원시완성두로자공진평소급미산성상,병우발병4.5h내급여아체보매용전치료(0.6 mg/kg).기록환자년령、용전전NIHSS평분、발병도개시용전시간등신식.DWI-ASPECTS평분위미산도상전순배피표주적10개구역,총분10분,매루급1개구역감거1분.장환자분위3조:0～5분16례,6～7분17례,8～10분20례.증상성로내출혈위용전치료후36 h경CT혹자공진증실적로내출혈,동시NIHSS평분승고4분이상.결과 53례환자중발생증상성로내출혈10례(18.8％),DWI-ASPECTS평분분별시0～5분6례(37.5％),6～7분3례(17.6％),8～10분1례(5.0％).여6～7분조、8～10분조비교,0～5분조환자출현증상성로내출혈적풍험명현승고(x2 =7.861,P=0.005).DWI-ASPECTS평분여증상성로내출혈구유량호적상관성,Logistic회귀모형분석현시:재교정년령、발병도개시용전시간등인소후,DWI-ASPECTS평분시증상성로내출혈적독립예측인소.결론 DWI-ASPECTS능예측결혈성졸중용전후증상성로내출혈적풍험,가작위용전전쾌속평개증상성로내출혈풍험적방법.
Objective To investigate whether the Alberta Stroke Programme Early CT Score applied to diffusion weighted imaging (DWI-ASPECTS) predicts symptomatic intracerebral hemorrhage (sICH) risk accurately.Methods In this retrospective study,continuously collected data of 53 patients at Department of Neurology,Baotou Central Hospital from 2010 to 2013 with anterior circulation stroke treated with standard intravenous tissue plasminogen activator (tPA;0.6 mg/kg) therapy within 4.5 hours after symptom onset were analyzed.All patients had completed the MRI scan and DWI at the time of admission.Patients age,NIHSS score on admission,time between symptom onset and thrombolytic treatment and other information were recorded.DWI-ASPECTS scores were calculated by the 10 regional diffusion image of anterior circulation marked,a total of 10 points,each involving a region minus 1 point.The patients were divided into 3 groups of 0-5 (n =16),6-7 (n =17),8-10 (n =20) based on DWI-ASPECTS scores.sICH was defined as CT-(or MRI-) documented hemorrhage that occurred within 36 hours after treatment onset and an elevated NIHSS score more than 4 points.Results Ten (18.8％) patients developed sICH.DWI-ASPECTS scores were 0-5 in 6 patients (37.5％),6-7 in 3 (17.6％) and 8-10 in 1 (5.0％),respectively.The sICH rate was significantly higher in patients with DWI-ASPECTS scores 0 to 5 as compared to patients with DWI-ASPECTS scores 6 to 7 and 8 to 10 (x2 =7.861,P =0.005).DWIASPECTS score and sICH had good correlation.Logistic regression analysis showed DWI-ASPECTS score was an independent prognostic factor of sICH when controlling for age and time to thrombolytic treatment.Conclusion DWI-ASPECTS can predict sICH risk after thrombolysis and may be helpful to quick sICH risk assessment before thrombolytic therapy.