摘要目的:探讨CT灌注成像(CT perfusion imaging, CTP)参数对急性前循环缺血性卒中患者静脉溶栓后临床转归的预测价值。方法:回顾性纳入2018年1月至2019年7月在苏州大学附属第一医院接受标准剂量阿替普酶静脉溶栓治疗并完成CTP检查及MIStar软件后处理的急性前循环缺血性卒中患者。收集患者临床资料以及CTP参数，包括灌注缺损(延迟时间>3 s)体积、缺血核心(相对脑血流量<30%)体积和缺血半暗带体积(灌注缺损-缺血核心体积)。根据发病后3个月时改良Rankin量表评分，将CTP存在灌注缺损的患者分为转归良好组(≤2分)和转归不良组(>2分)。采用多变量 logistic回归模型评价CTP参数与临床转归的相关性。采用受试者工作特征(receiver operating characteristic, ROC)曲线评价CTP参数对临床转归的预测价值。 结果:共纳入173例符合患者，其中108例CTP存在缺血灌注异常。单变量分析显示，转归良好组年龄、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、基线血糖水平、心房颤动病史、灌注缺损体积、缺血核心体积以及缺血半暗带体积与转归不良组差异有统计学意义( P均<0.05)。多变量 logistic回归分析显示，灌注缺损体积较大[优势比(odds ratio, OR)1.013，95%可信区间(confidence interval, CI)1.001～1.025； P＝0.042]和基线NIHSS评分较高( OR 1.260，95% CI 1.129～1.407； P<0.001)为患者转归不良的独立危险因素。ROC曲线分析显示，灌注缺损体积预测转归不良的曲线下面积为0.792(95% CI 0.700～0.883； P<0.001)；最佳截断值为108.5 ml，对应的敏感性和特异性分别为60.9%和92.2%。 结论:基于CTP的MIStar软件分析参数可用于评估急性前循环缺血性卒中患者静脉溶栓治疗后的临床转归。灌注缺损体积>108.5 ml预测急性前循环缺血性卒中患者静脉溶栓治疗后转归不良的价值较高。

abstractsObjective:To investigate the predictive value of CT perfusion imaging (CTP) parameters for the clinical outcome of patients with acute anterior circulation ischemic stroke after intravenous thrombolysis.Methods:Patients with acute anterior circulation ischemic stroke received standard-dose intravenous thrombolysis with alteplase and completed CTP examination and post-processing with MIStar software from January 2018 to July 2019 in the First Affiliated Hospital of Soochow University were enrolled retrospectively. Clinical data and CTP parameters of the patients were collected, including perfusion defect volume (delayed time >3 s), ischemic core volume (relative cerebral blood flow <30%) and ischemic penumbra volume (perfusion defect-ischemic core volume). According to the modified Rankin Scale score at 3 months after onset, patients with perfusion defect on CTP were divided into good outcome group (≤2) and poor outcome group (>2). Multivariable logistic regression model was used to evaluate the correlation between CTP parameters and clinical outcomes. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of CTP parameters for clinical outcomes. Results:A total of 173 eligible patients were enrolled, of which 108 had abnormal ischemic perfusion on CTP. Univariate analysis showed that there were significant differences in age, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline blood glucose level, history of atrial fibrillation, perfusion defect volume, ischemic core volume and ischemic penumbra volume between the good outcome group and the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that larger perfusion defect volume (odd ratio [ OR] 1.013, 95% confidence interval [ CI] 1.001-1.025; P=0.042) and higher baseline NIHSS score ( OR 1.260, 95% CI 1.129-1.407; P<0.001) were the independent risk factors for poor outcomes. ROC curve analysis showed that the area under the curve for perfusion defect volume predicting poor outcome was 0.792 (95% CI 0.700-0.883; P<0.001); the best cut-off value was 108.5 ml, the corresponding sensitivity and specificity were 60.9% and 92.2%, respectively. Conclusion:CTP-based MIStar software analysis parameters can be used to evaluate the clinical outcomes of patients with acute anterior circulation ischemic stroke after intravenous thrombolysis. Perfusion defect volume >108.5 ml has a higher value in predicting the poor outcomes of patients with acute anterior circulation ischemic stroke after intravenous thrombolytic therapy.