CTP参数对短暂性脑缺血发作近期进展为急性脑梗死的预测价值探讨

Predictive value of CTP parameters for the short-term progression from transient ischemic attack to acute cerebral infarction

摘要:

目的 探讨计算机断层扫描灌注成像(CTP)参数对短暂性脑缺血发作(TIA)近期进展为急性脑梗死(ACI)的预测价值。方法 回顾性分析2017年4月至2020年12月该院收治的176例TIA患者的临床资料，随访3个月，将进展为ACI的25例患者纳入ACI组，未进展为ACI的151例患者纳入非ACI组。对比2组患者基线资料、脑部CTP参数，并分析CTP参数对评估TIA后3个月发生ACI的预测价值。结果 176例TIA患者中，有25例进展为ACI，ACI发生率为14.20%。ACI组与非ACI组在性别、身体质量指数、TIA类型比较，差异均无统计学意义(P>0.05)。ACI组年龄、合并高血压、合并糖尿病、合并高脂血症占比均高于非ACI组，差异有统计学意义(P<0.05)；脑部CTP参数中，ACI组患者脑血流量(CBF)、脑血容量(CBV)水平低于非ACI组，差异有统计学意义(P<0.05)；ACI组患者平均通过时间(MTT)、最大峰值时间(TTP)水平高于非ACI组，差异有统计学意义(P<0.05)。CBF、CBV、MTT、TTP评估TIA进展为ACI的Cut-off值分别为33.26 mL/(100 g·min)、2.04 mL/100 g、11.33 s、16.08 s；各项指标联合评估TIA进展为ACI的灵敏度为100%；特异度与各项指标单独评估比较，差异无统计学意义(P>0.05)；AUC均高于各项指标单独评估(P<0.05)。结论 TIA近期进展为ACI过程中CTP参数会发生变化，即CBF、CBV水平下降，MTT、TTP水平升高。CBF、CBV、MTT、TTP及各项指标联合对评估TIA进展为ACI均有一定的预测价值，且各项指标联合对ACI的预测价值更佳。

Abstract:

Objective To evaluate the predictive value of computed tomography perfusion （CTP） parameters for the short-term progression from transient ischemic attack （TIA） to acute cerebral infarction （ACI）.Methods A retrospective analysis was performed on the clinical data of 176 patients with TIA who were admitted to The Fourth Hospital of Changsha from April 2017 to December 2020. The patients were followed up for 3 months， and 25 patients who progressed to ACI were included in the ACI group and 151 patients who did not progress to ACI were included in the non-ACI group. The two groups were compared in terms of baseline data and brain CTP parameters， and the value of CTP parameters in predicting the development of ACI within 3 months after TIA was analyzed.Results Among the 176 TIA patients， 25 （14.20%） progressed to ACI within 3 months. There were no significant differences in sex， body mass index， and TIA type between the ACI group and the non-ACI group （P>0.05）， but the ACI group had significantly higher age and proportions with hypertension， diabetes， and hyperlipidemia compared with the non-ACI group （P<0.05）. In terms of brain CTP parameters， the ACI group had significantly lower levels of cerebral blood flow （CBF） and cerebral blood volume （CBV） and significantly longer time to peak （TTP） and mean transit time （MTT） compared with the non-ACI group （P<0.05）. The Cut-off values of CBF， CBV， MTT， and TTP for assessing TIA progression to ACI were 33.26 mL/100g·min^-1， 2.04 mL/100g， 11.33 s， and 16.08 s， respectively. A combination of the four parameters for assessing TIA progression to ACI had a sensitivity of 100%， but its specificity was not significantly different from that of each parameter alone （P>0.05）.Conclusions The CTP parameters will change with the short-term progression of TIA to ACI， namely CBF and CBV decrease， while MTT and TTP increase. CBF， CBV， MTT， TTP， and the combination of the four have certain predictive value for assessing TIA progression to ACI， and the latter has a better predictive value.