液体衰减反转恢复成像与急性脑梗死静脉溶栓治疗后临床神经功能转归的相关性研究

摘要

Objective To study the relationship of FHP and FHA on FLAIR images with neurological recovery in acute ischemic stroke (AIS) patients after intravenous thrombolysis.Methods Eighty-two AIS patients admitted to our hospital for intravenous thrombolysis with rt-PA were included in this study.The patients who underwent brain MRI before intravenous thrombolysis were divided in positive FLAIR group (n=23) and negative FLAIR group (n =59) according to the FHP and FHA on FLAIR images.Their neurological function was assessed according to the mRS 3 months after intravenous thrombolysis.Results The incidence of conducting arterostenosis or occlusion and the NIHSS score were significantly higher while the ischemic lesion size on DWI was significantly larger in positive FLAIR group than in negative FLAIR group (P＜0.05,P＜0.01).Of the 23 patients in positive FLAIR group,14 showed FHP,16 showed FHP,and 7 showed both FHP and FHP on FLAIR images.Logistic regression analysis revealed that hypertension,NIHSS score on admission,high FLAIR signal,FHP and FHA were the risk factors for poor neurological recovery (OR =0.04,95 ％ CI:0.00-0.50,P =0.012;OR =1.32,95 ％ CI:1.08-1.57,P=0.005;OR=6.21,95％CI:1.05-36.65,P=0.044;OR=14.45,95％CI:1.32-158.51,P=0.029).Conclusion FHP and FHA on FLAIR images can predict the neurological recovery in AIS patients after intravenous thrombolysis.%目的 探讨急性脑梗死患者磁共振液体衰减反转恢复(FLAIR)序列出现脑实质高信号(FHP)和(或)血管高信号(FHA)与静脉溶栓后临床神经功能转归的相关性.方法 选择连续收治的发病时间＜4.5h,并自愿接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的急性脑梗死患者82例.在溶栓前行头颅MRI检查,根据FLAIR序列上有无FHP、FHA,分为阳性组23例和阴性组59例.静脉溶栓3个月后,采用改良Rankin量表(mRS)进行临床神经功能评估.结果 阳性组患者的大动脉狭窄或闭塞、入院时美国国立卫生研究院卒中量表(NIHSS)评分和基线弥散加权成像(DWI)缺血损害体积明显高于阴性组(P＜0.05,P＜0.01).阳性组14例FHP,16例FHA,7例FHP合并FHA.logistic回归分析发现,神经功能恢复不良的影响因素有高血压(OR=0.04,95％CI:0.00～0.50,P=0.012)、入院时NIHSS(OR=1.32,95％ CI:1.08～1.57,P=0.005)、1个FLAIR高信号(OR=6.21,95％CI:1.05～36.65,P=0.044)和FHP合并FHA(OR=14.45,95％CI:1.32～158.51,P=0.029).结论 急性脑梗死患者早期头颅MRI FLAIR序列出现FHP和(或)FHA是预测急性脑梗死患者溶栓治疗后临床转归简单、易操作的方法.