CTPI参数联合血清生化指标在急性脑梗死病情评估及阿替普酶溶栓效果分析中的应用价值研究

周畅; 陆悌明; 贺俊峰

CTPI参数联合血清生化指标在急性脑梗死病情评估及阿替普酶溶栓效果分析中的应用价值研究

Study on the application value of CTPI parameters combined with serum biochemical indicators in the assessment of acute cerebral infarction and analysis of alteplase thrombolysis effects

摘要

摘要:
目的： 研究头颅CT灌注成像（CTPI）参数联合血清生化指标在急性脑梗死（ACI）病情评估及阿替普酶溶栓效果分析中的应用价值。
方法： 选取122例ACI病人，按照美国国立卫生研究院卒中量表（NIHSS）评分分为轻度组（NIHSS评分＜ 5分）29例、中度组（NIHSS评分为5～15分）66例和重度组（NIHSS评分＞ 15分）27例，均给予阿替普酶溶栓，按照溶栓效果分为有效组84例和无效组38例，比较各组CTPI参数、血清生化指标，并分析CTPI参数联合血清生化指标对溶栓效果的预测价值。
结果： 中度组、重度组脑血容量（CBV）、脑血流量（CBF）比较：重度组＜中度组＜轻度组（P ＜ 0.05），平均通过时间（MTT）、达峰时间（TTP）、同型半胱氨酸（Hcy）、尿酸、小而密低密度脂蛋白胆固醇（sdLDL-C）比较：重度组＞中度组＞轻度组，差异均有统计学意义（P ＜ 0.05）。无效组CBF、CBV相较于有效组更低（P ＜ 0.05），无效组TTP、MTT、Hcy、尿酸、sdLDL-C相较于有效组明显更高（P ＜ 0.01）。ROC曲线分析得出，CBF、CBV、TTP、MTT、Hcy、尿酸、sdLDL-C、联合预测溶栓效果的AUC分别为0.834、0.625、0.756、0.686、0.699、0.722、0.709、0.938。
结论： ACI病情越严重，CBF、CBV越低，TTP、MTT、Hcy、尿酸、sdLDL-C越高，CTPI参数联合血清生化指标在ACI溶栓效果中具有较高的预测价值。

Abstract:
Objective To investigate the application value of head CT perfusion imaging (CTPI) parameters combined with serum biochemical indicators in the evaluation of acute cerebral infarction (ACI) and analysis of the thrombolytic effects of ateplase.
Methods A total of 122 patients with ACI were selected, and divided into the mild group (NIHSS score ＜ 5) (29 cases), moderate group (NIHSS score 5-15) (66 cases) and severe group (NIHSS score ＞ 15) ( 27 cases) according to the National Institutes of Health Stroke Scale (NIHSS) score. All patients were given alteplase thrombolysis. According to the thrombolytic effect, the patients were divided into the effective group (84 cases) and ineffective group (38 cases). The CTPI parameters and serum biochemical indicators between two groups were compared, and the predictive value of combination of CTPI parameters and serum biochemical indicators for the thrombolytic effects was analyzed.
Results Comparison of the cerebral blood volume (CBV) and cerebral blood flow (CBF) between the moderate group and severe group: severe group ＜ moderate group ＜ mild group (P ＜ 0.05). Comparison of the mean transit time (MTT), time to peak (TTP), homocysteine (Hcy), uric acid and small dense low-density lipoprotein cholesterol (sdLDL-C): Severe group ＞ moderate group ＞ mild group, and the differences were all statistically significant (P ＜ 0.05). The CBF and CBV in the ineffective group were lower than those in effective group (P ＜ 0.05), while the TTP, MTT, Hcy, uric acid and sdLDL-C in the ineffective group were significantly higher than those in effective group (P ＜ 0.01). The results of ROC curve analysis showed that the AUCs of CBF, CBV, TTP, MTT, Hcy, uric acid, sdLDL-C and combined prediction of thrombolytic effect were 0.834, 0.625, 0.756, 0.686, 0.699, 0.722, 0.709, and 0.938, respectively.
Conclusions The more severe the ACI condition is, the lower the CBF and CBV will be, and the higher the TTP, MTT, Hcy, uric acid and sdLDL-C will be. The CTPI parameter combined with serum biochemical indicators has a high predictive value in the thrombolytic effect of ACI.The more severe the condition of ACI, the lower the CBF and CBV, and the higher the TTP, MTT, Hcy, uric acid, and sdLDL-C. The combination of CTPI parameters and serum biochemical indicators has high predictive value in the thrombolytic effect of ACI.

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