多时相CT血管造影对急性缺血性脑卒中患者侧支循环评估价值及溶栓治疗指导作用

目的探讨多时相CT血管造影(CTA)对急性缺血性脑卒中(AIS)患者侧支循环评估价值及溶栓治疗指导作用。方法我院收治的AIS患者,选取其中接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的120例患者为研究对象。治疗前均给予多时相CTA检查,根据影像学检查结果及Alberta卒中项目早期CT评分(ASPECTS)分为侧支循环良好组及侧支循环不良组。收集两组基线资料,并比较入院时、溶栓治疗24 h及2周后的神经功能美国国立卫生院神经功能缺损评分(NIHSS)量表、28 d内死亡率及随访3个月后的预后情况改良Rankin评分量表(mRS)。分析AIS患者侧支循环血流总体评分(ASPECTS)与预后(mRS)之间的相关性。结果两组性别、年龄、体质指数(BMI)、合并症、栓塞部位比较差异无统计学意义(P>0.05),侧支循环不良组介入干预率高于侧支循环良好组(P<0.05);入院时,两组NIHSS量表评分比较差异无统计学意义(P>0.05),溶栓治疗24 h及2周后,两组NIHSS量表评分均较入院时下降,且组间比较差异有统计学意义(P<0.05);两组28 d内死亡率比较差异无统计学意义(P>0.05),随访3个月后侧支循环良好组的mRS评分更低(P<0.05);AIS患者ASPECTS与mRS之间呈负相关(r=-0.396,P<0.05)。结论多时相CTA对于静脉溶栓治疗的AIS患者可为其提供理想的参考价值,通过判断其侧支代偿,有利于早期制定治疗方案,以改善预后。

The value of multi-phase CT angiography in evaluation of collateral circulation in patients with acute ischemic stroke and its guiding role for thrombolytic therapy

Objective To explore the value of multi-phase CT angiography(CTA)in evaluation of collateral circulation in patients with acute ischemic stroke(AIS)and its guiding role for thrombolytic therapy.Methods We selected 120 patients with AIS who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)as research subjects.Multi-phase CTA examination was performed before treatment.According to the imaging examination results and Alberta Stroke Program Early CT Score(ASPECTS),the patients were divided into good collateral circulation group and poor collateral circulation group.The baseline data were collected in the two groups,and the neurological function estimated by sing National Institutes of Health Stroke Scale(NIHSS)at admission and after 24 h and 2 weeks of thrombolytic therapy,mortality rate within 28 days and prognosis estimated by using Modified Rankin Scale(mRS)after 3 months of follow-up were compared among the patients.Spearman correlation analysis was used to evaluate the correlation between overall score of ASPECTS and mRS of patients with AIS.Results There were no significant differences in the gender,age,body mass index(BMI),comorbidities and embolization sites between the two groups(P>0.05).The interventional rate in the poor collateral circulation group was significantly higher than that in the good collateral circulation group(P<0.05).At admission,there was no statistically significant difference in the NIHSS scale score between the two groups(P>0.05).After 24 h and 2 weeks of thrombolytic therapy,the NIHSS scale scores of the two groups were lower than those at admission,and there was a statistically significant difference between the two groups(P<0.05).There was no statistically significant difference in the mortality rate within 28 days between the two groups(P>0.05),and the mRS score in the good collateral circulation group was significantly lower after 3 months of follow-up(P<0.05).According to Spearman correlation analysis,there was a significant negative correlation between overall score of ASPECTS and mRS in patients with AIS(r=-0.396,P<0.05).Conclusion Multi-phase CTA can provide an ideal reference value for patients with AIS undergoing intravenous thrombolysis.It is helpful to formulate early treatment regimens to improve the prognosis by judging the collateral compensation.