作者：张乾营1，刘旭红1，戴为正2，黄莹1，何桂凤1，傅懋林2

单位：

1.362000福建省泉州市，中国人民解放军联勤保障部队第九一〇医院放射诊断科　2.362000福建省泉州市，中国人民解放军联勤保障部队第九一〇医院神经内科

Units：

1.Department of Radiology, the 910th Hospital, Quanzhou 362000, China2.Department of Nneurology, the 910th Hospital, Quanzhou 362000, China

关键词：

脑梗死；症状性大脑中动脉狭窄；标准化管壁指数；预测

Keywords：

Brain infraction; Symptomatic middle cerebral artery stenosis; Normalized wall index; Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.197

Funds：

摘要：

目的　探讨标准化管壁指数（NWI）对症状性大脑中动脉狭窄患者发生脑梗死的预测价值。方法　选取中国人民解放军联勤保障部队第九一〇医院2020年1月至2021年4月收治的48例症状性大脑中动脉狭窄（经MRA检查证实狭窄程度≥50%）患者。将DWI检查阳性患者纳入梗死组，DWI检查阴性患者纳入短暂性脑缺血发作（TIA）组。所有患者分别于住院后第1、30、90、180天行HR-MRI检查。比较两组不同时间NWI，采用ROC曲线分析不同时间NWI对症状性大脑中动脉狭窄患者发生脑梗死的预测价值。结果　 有8例患者退出本研究，其中梗死组3例、TIA组5例；为使两组患者例数一致，按照随机原则剔除TIA组5例患者，最终共纳入40例患者，梗死组、TIA组各20例。组别与时间在NWI上不存在交互作用（P ＞0.05）；组别、时间在NWI上主效应均显著（P ＜0.05）。两组患者住院后第180天NWI分别低于本组住院后第1天，且住院后第1、30、90、180天梗死组患者NWI大于TIA组（P ＜0.05）。ROC曲线分析结果显示，住院后第1、30、90、180天NWI预测症状性大脑中动脉狭窄患者发生脑梗死的AUC分别为0.916〔95%CI（0.831，1.000）〕、0.885〔95%CI （0.782，0.988）〕、0.826〔95%CI （0.690，0.962）〕、0.955〔95%CI （0.732，0.978）〕，最佳截断值分别为0.765、0.705、0.600、0.610，灵敏度分别为85%、85%、85%、85%，特异度分别为90%、85%、75%、85%。结论　NWI对症状性大脑中动脉狭窄患者发生脑梗死有较高的预测价值，当症状性大脑中动脉狭窄患者斑块承载动脉的NWI＞0.765时，需要警惕脑梗死的发生。

Abstract：

Objective　To investigate the predictive value of normalized wall index (NWI) for cerebral infarctionin patients with symptomatic middle cerebral artery stenosis. Methods　A total of 48 patients with symptomatic middlecerebral artery stenosis (stenosis degree ≥ 50% confirmed by MRA) admitted to the 910th Hospital from January 2020 toApril 2021 were selected. The patients with positive DWI examination were included in the infarction group, and those withnegative DWI examination were included in the teansient ischemic attack (TIA) group. All patients underwent HR-MRIexamination on the 1st, 30th, 90th, and 180th days after hospitalization, respectively. NWI at different time was comparedbetween the two groups. The predictive value of NWI for cerebral infarction in patients with symptomatic middle cerebralartery stenosis was analyzed by ROC curve. Results　A total of 8 patients withdrew from the study, including 3 patients inthe infarction group and 5 patients in the TIA group. In order to make the number of patients in the two groups consistent, 5patients in the TIA group were excluded according to the principle of randomization, and a total of 40 patients were finallyincluded, with 20 patients in the infarction group and 20 patients in the TIA group. There was no interaction between groupand time on NWI (P > 0.05) ; the main effects of group and time on NWI were significant (P < 0.05) . The NWI at 180thdays after hospitalization in the two groups was lower than that at 1st day after hospitalization respectively, and the NWIat 1st, 30th, 90th, and 180th days after hospitalization in the infarction group was greater than that in the TIA group (P <0.05) . ROC curve analysis showed that, the AUC of NWI on the 1st, 30th, 90th, and 180th days after hospitalization forpredicting cerebral infarction in patients with symptomatic middle cerebral artery stenosis was 0.916 [95%CI (0.831, 1.000) ] ,0.885 [95%CI (0.782, 0.988) ] , 0.826 [95%CI (0.690, 0.962) ] , 0.955 [95%CI (0.732, 0.978) ] , the best cutoff values were 0.765,0.705, 0.600, and 0.610, the sensitivity was 85%, 85%, 85%, and 85%, and the specificity was 90%, 85%, 75%, and 85%,respectively. Conclusion　 NWI has good predictive value for cerebral infarction in patients with symptomatic middle cerebralartery stenosis. When the NWI of the plaque-bearing artery in patients with symptomatic middle cerebral artery stenosis is greaterthan 0.765, it is necessary to be alert to the occurrence of cerebral infarction.

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