作者：胡骁1 ，申松波1 ，马迎辉1 ，胡胜1 ，邱晓明2

单位：

1.423500湖北省黄石市中心医院 湖北理工学院附属医院神经外科　2.423500湖北省黄石市中心医院 湖北理 工学院附属医院放射科

Units：

1.Department of Neurosurgery, Huangshi Central Hospital/Affiliated Hospital of Hubei Institute of Technology, Huangshi 423500, China 2.Department of Radiology, Huangshi Central Hospital/Affiliated Hospital of Hubei Institute of Technology, Huangshi 423500, China

关键词：

　卒中；急性大血管闭塞性缺血性卒中；金属征；CT灌注成像；介入取栓；出血转化

Keywords：

Stroke; Acute ischemic stroke with large vesselocclusion; Metallic hyperdensity sign; CT perfusion imaging; Interventional thrombectomy; Hemorrhagic transformation

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2024.00.021

Funds：

湖北省自然科学基金资助项目（2019CFB115）

摘要：

目的　探讨CT平扫“金属征”和CT灌注成像（CTP）指标与急性大血管闭塞性脑卒中（AIS-LVO） 患者介入取栓后发生出血转化（HT）的关系。方法　选取2019—2022年黄石市中心医院收治的介入取栓后发生HT 的AIS-LVO患者67例为HT组，另选取同期黄石市中心医院收治的介入取栓后未发生HT的AIS-LVO患者120例为对照 组。比较两组患者临床资料、CT平扫“金属征”检出率及CTP指标，AIS-LVO患者介入取栓后发生HT的影响因素分 析采用多因素Logistic回归分析；计算CT平扫“金属征”预测AIS-LVO患者介入取栓后发生HT的正确率，绘制ROC 曲线以评估CTP指标对AIS-LVO患者介入取栓后发生HT的预测价值。结果　两组入院时美国国立卫生研究院卒中量 表（NIHSS）评分、入院时格拉斯哥昏迷量表（GCS）评分、取栓次数、闭塞血管、接受抗血小板治疗者占比、CT 平扫“金属征”检出率、脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）、达峰时间（TTP）、表面 通透性（PS）比较，差异有统计学意义（P＜0.05）。多因素Logistic回归分析结果显示，入院时NIHSS评分、取栓次 数、接受抗血小板治疗、CT平扫“金属征”、CBF是AIS-LVO患者介入取栓后发生HT的独立影响因素（P＜0.05）。 对照组无CT平扫“金属征”96例，HT组有CT平扫“金属征”55例。CT平扫“金属征”预测AIS-LVO患者介入取栓 后发生HT的正确率为80.7%（151/187）。ROC曲线分析结果显示，CBF、CBV、MTT、TTP、PS预测AIS-LVO患者介 入取栓后发生HT的AUC分别为0.804〔95%CI（0.741～0.866）〕、0.616〔95%CI（0.532～0.699）〕、0.782〔95%CI （0.711～0.851）〕、0.719〔95%CI（0.642～0.796）〕、0.801〔95%CI（0.733～0.869）〕。结论　CT平扫“金属 征”和CBF是AIS-LVO患者介入取栓后发生HT的独立影响因素，且CT平扫“金属征”、CBF和PS对AIS-LVO患者介入 取栓后发生HT具有一定预测价值。

Abstract：

Objective To investigate the relationship between CT plain scan "metallic hyperdensity sign" and CT perfusion imaging (CTP) indexes and hemorrhagic transformation (HT) after interventional thrombectomy in patients with acute ischemic stroke with large vesselocclusion (AIS-LVO) . Methods From 2019 to 2022, 67 cases AIS-LVO patients with HT after interventional thrombectomy in Huangshi Central Hospital were selected as HT group, and 120 cases AIS-LVO patients without HT after interventional thrombectomy in Huangshi Central Hospital in the same period were selected as control group. The clinical data, detection rate of CT plain scan "metallic hyperdensity sign" , and CTP indexes were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the influencing factors of HT after interventional thrombectomy in AIS-LVO patients. The accuracy of CT plain scan "metallic hyperdensity sign" for predicting HT after interventional thrombectomy in patients with AIS-LVO was calculated. ROC curve was drawn to analyze the predictive value of CTP indexes for HT after interventional thrombectomy in patients with AIS-LVO. Results There were statistically significant differences in National Institutes of Health Stroke Scale (NIHSS) score at admission, Glasgow Coma Scale (GCS) score at admission, number of thrombectomy, occluded vessels, proportion of patients receiving antiplatelet therapy, detection rate of CT plain scan "metallic hyperdensity sign" , cerebral blood flow (CBF) , cerebral blood volume (CBV) , mean transit time (MTT) , time to peak (TTP) , permeability surface (PS) between the two groups (P < 0.05) . Multivariate Logistic regression analysis showed that NIHSS score at admission, number of thrombectomy, antiplatelet therapy, CT plain scan 'metallic hyperdensity sign' and CBF were independent influencing factors of HT after interventional thrombectomy in AIS-LVO patients (P < 0.05) . There were 96 cases without CT plain scan "metallic hyperdensity sign" in the control group, and 55 cases with CT plain scan "metallic hyperdensity sign" in the HT group. The accuracy of CT plain scan "metallic hyperdensity sign" in predicting HT after interventional thrombectomy in AIS LVO patients was 80.7% (151/187) . ROC curve analysis showed that the AUC of CBF, CBV, MTT, TTP and PS in predicting HT after interventional thrombectomy in AIS-LVO patients were 0.804 [95%CI (0.741-0.866) ] , 0.616 [95%CI (0.532-0.699) ] , 0.782 [95%CI (0.711-0.851) ] , 0.719 [95%CI (0.642-0.796) ] and 0.801 [95%CI (0.733-0.869) ] , respectively. Conclusion CT plain scan "metallic hyperdensity sign" and CBF are independent influencing factors for HT after interventional thrombectomy in AIS-LVO patients, and CT plain scan "metallic hyperdensity sign" , CBF and PS have certain predictive value for HT after interventional thrombectomy in AIS-LVO patients.

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