侧支循环状态对AIS皮质静脉征的评估及对预后的影响

目的 磁敏感加权成像（SWI）上的不对称突出皮质静脉（APCV）征常用于评估急性缺血性卒中（AIS）,旨在探讨不同侧支循环状态病人的APCV征显示情况,并评价该征对急性大脑中动脉（MCA）供血区AIS病人预后的预测能力。 方法 回顾性分析MCA供血区AIS病人72例,男44例,女28例,平均年龄（53.78±7.88）岁。根据区域性软脑膜侧支（rLMC）评分将全部病人分为侧支循环不良（rLMC≤10）及良好（rLMC>10）,计算APCV征的阳性率并进行比较。采用Spearman相关系数评估APCV征与rLMC评分相关性。根据有无APCV征将病人分为APCV阳性组和APCV阴性组,2组间计量资料比较采用独立样本 t 检验或 Mann-Whitney U检验,计数资料比较采用χ²检验。采用多因素Logistic回归分析评估AIS预后的影响因素。 结果 72例AIS病人中侧支循环不良者26例,良好者46例。侧支循环不良病人的APCV征阳性率（20/26例,76.92%）高于良好的病人（22/46例,47.83%）（P<0.05）。APCV征与rLMC评分之间呈负相关（r=-0.364,P=0.002）。侧支循环不良的病人中,APCV征阳性组的发病时间、检查时间及2周后美国国立卫生研究院卒中量表（NIHSS）评分均高于阴性组（均P<0.05）。侧支循环良好的病人中,APCV征阳性组与阴性组各指标间差异均无统计学意义（均P>0.05）。多因素Logistic回归分析显示,对于全部AIS病人和侧支循环良好的病人,rLMC评分及2周后NIHSS评分是预后不良的独立预测因子（P<0.05）,APCV征无独立预测价值（P>0.05）;但对于侧支循环不良的病人,APCV征为预后不良的独立预测因子（P<0.05）。 结论 侧支循环不良的AIS病人APCV征更常见,且与神经功能预后不良有关。根据APCV征评估AIS功能预后时,应首先考虑侧支循环状态。

Effect of collateral circulation status on asymmetrical prominent cortical veins and prognosis in acute ischemic stroke patients

Objective Asymmetrical prominent cortical veins(APCV) on SWI has often been employed in the evaluation of acute ischemic stroke (AIS). The aim of this study was to investigate the effect of collateral circulation status on presence of APCV, and to assess the APCV on prognosis of AIS in the middle cerebral artery (MCA) territory. Methods Seventy-two patients with AIS in the MCA territory were retrospectively analyzed. There were 44 males and 28 females, with an average age of 53.78±7.88 years. All patients were divided into poor collateral circulation (rLMC≤10) and good collateral circulation (rLMC>10) according to regional leptomeningeal collateral (rLMC) score, and the positive rate of APCV was calculated and compared. Spearman correlation coefficient was used to evaluate the correlation between APCV and rLMC score. According to the presence of APCV, patients were divided into APCV positive and negative group. The independent sample t test or Mann-Whitney U test was used to compare the measurements, and the Chi-square test was used to compare the categorical data between the two groups. Multivariate logistic regression analysis was used to identify the risk factors of AIS. Results There were 26 cases with poor collateral circulation and 46 cases with good collateral circulation in the 72 patients of AIS. The positive rate of APCV in poor collateral circulation (20/26, 76.92%) was higher than that in good collateral circulation (22/46, 47.83%) (P<0.05). Negative correlation (r=-0.364, P=0.002) was found between APCV and rMCL score. In the poor collateral circulation patients, the onset time, checking time, and NIHSS score after 2 week were significantly higher in the APCV positive group than in the negative group (all P<0.05), while the indexes did not significantly differ between the two groups in the good collateral circulation patients (all P>0.05). The multiple-factor logistic analysis showed that rMCL score and NIHSS score after 2 week were independent risk factors for poor prognosis of AIS (P<0.05), while the APCV had no predictive value (P>0.05) in all or good collateral circulation patients; the APCV was independent risk factor for poor prognosis of AIS in the poor collateral circulation patients (P<0.05). Conclusion In those patients with poor collateral circulation, the APCV often presents and associats with unfavorable prognosis. When APCV sign is employed for prognosis assessment in AIS patients, the collateral circulation state should be evaluated at first.