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投稿时间：2023-10-13 网络发布日期：2024-07-20
投稿时间：2023-10-13 网络发布日期：2024-07-20
中文摘要: 目的 探讨全脑CT灌注（CTP）成像参数及血清基质金属蛋白酶-9（MMP-9）水平在急性脑梗死（ACI）血管内治疗后出血转化中的预测意义。
方法 以武汉市第一医院2021年6月至2022年9月收治的46例行血管内支架机械取栓治疗的ACI患者为回顾性研究对象。血管内治疗前行常规CT平扫、CTP及血清MMP-9检查，计算CTP患侧与健侧对称部位比值得到相对参数值：相对脑血容量（rCBV）、相对脑血流量（rCBF）、相对平均通过时间（rMTT）、相对达峰时间（rTTP）和相对表面渗透性(rPS)。根据治疗7d内复查的CT平扫图像有无发生出血转化分为出血组和未出血组。采用Spearman秩相关分析CTP参数、血清MMP-9水平与出血转化的相关性，并评估其对ACI血管内治疗后出血转化的预测效能。
结果 46例患者中，12例发生出血转化（出血组），34例未发生出血转化（未出血组）。出血组rCBV、rCBF较未出血组患者低，rPS、PS、rTTP、MMP-9较未出血组高，差异有统计学意义(P＜0.05)；两组rMTT差异无统计学意义(P＞0.05)。rPS、PS、rTTP、MMP-9分别与出血转化呈正相关（P＜0.01），rCBV、rCBF分别与出血转化呈负相关（P＜0.01）；其中MMP-9与出血转化相关性最强（r=0.752，P＜0.01），rPS次之（r=0.664，P＜0.01）。rCBV、rCBF、rTTP、PS、rPS和MMP-9预测出血转化的ROC曲线下面积（AUC）分别为0.794、0.755、0.750、0.848、0.936和0.863，以rPS最高。
结论 CTP参数变化及血清MMP-9增高在预测ACI血管内治疗后出血转化中有重要意义，可为患者血管内治疗提供指导。
Abstract:Objective To explore the value of whole brain CT perfusion (CTP) imaging parameters and serum MMP-9 level in predicting hemorrhagic transformation (HT) after endovascular therapy of acute cerebral infarction (ACI).
Methods A retrospective study was conducted on 46 patients with ACI who underwent endovascular stent mechanical thrombectomy in Wuhan No.1 Hospital from June 2021 to September 2022. Routine CT plain scan, CTP, and serum MMP-9 examination were performed before endovascular treatment, and the symmetrical site ratio between the affected side and the unaffected side of CTP was calculated to obtain the relative parameter values: relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT), relative time to peak (rTTP) and relative permeability surface (rPS). According to whether the CT images re-examined within 7 days of treatment had HT, the patients were divided into HT group and non-HT group. Spearman rank correlation analysis was used to analyze the correlation of HT with CTP parameters and serum MMP-9 level, and to evaluate the predictive efficacy of the two indexes on HT after endovascular treatment of ACI.
Results Of the 46 patients, HT occurred in 12 patients and non-HT in 34 patients. Compared with non-HT group, rCBV and rCBF decreased,while rPS, PS, rTTP and MMP-9 increased in HT group (P＜0.05). However, there was no statistically significance of rMTT between the two groups (P＞0.05). rPS, PS, rTTP and MMP-9 were positively correlated with HT (P＜0.01), and rCBV and rCBF were negatively correlated with HT (P＜0.01), respectively.Among them, MMP-9 was most strongly correlated with HT (r=0.752,P＜0.01), followed by rPS (r=0.664,P＜0.01). The area under curve (AUC) of rCBV, rCBF, rTTP, PS, rPS and MMP-9 in predicting HT was 0.794, 0.755, 0.750, 0.848, 0.936 and 0.863, respectively, with rPS being the highest.
Conclusion The changes in CTP parameters and the increase of serum MMP-9 level are of great significance in predicting the HT after endovascular treatment of ACI, which can provide a guidance for endovascular treatment of patients.
keywords: Acute cerebral infarction Endovascular therapy Hemorrhagic transformation CT perfusion imaging Relative permeability surface Matrix metalloproteinase-9
文章编号： 中图分类号：R743.3 文献标志码：A
基金项目:湖北省卫生健康委基金项目（WJ2019M026）
| Author Name | Affiliation |
| JIANG Weili, LONG Bin, ZHANG Wei | Department of Radiology, Wuhan No.1 Hospital, Wuhan, Hubei 430022, China |
引用文本：
蒋玮丽，龙斌，张蔚.全脑CT灌注成像及血清MMP-9水平对急性脑梗死后出血转化的预测价值[J].中国临床研究,2024,37(7):1075-1079.
蒋玮丽，龙斌，张蔚.全脑CT灌注成像及血清MMP-9水平对急性脑梗死后出血转化的预测价值[J].中国临床研究,2024,37(7):1075-1079.