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  • 张萍,张敏敏,杨鹏飞,陆建平,刘建民,张永巍,邓本强.RAPID软件在急性缺血性脑卒中血管内治疗患者预后预测中的应用价值[J].第二军医大学学报,2018,39(9):1013-1018    [点击复制]
  • ZHANG Ping,ZHANG Min-min,YANG Peng-fei,LU Jian-ping,LIU Jian-min,ZHANG Yong-wei,DENG Ben-qiang.Application of RAPID software in predicting prognosis of acute ischemic stroke patients with endovascular treatment[J].Acad J Sec Mil Med Univ,2018,39(9):1013-1018   [点击复制]
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RAPID软件在急性缺血性脑卒中血管内治疗患者预后预测中的应用价值
张萍1,张敏敏1,杨鹏飞1,陆建平2,刘建民1*,张永巍1,邓本强1*
0
(1. 海军军医大学(第二军医大学)长海医院脑血管病中心, 上海 200433;
2. 海军军医大学(第二军医大学)长海医院影像医学科, 上海 200433
*通信作者)
摘要:
目的 探讨基于脑计算机断层扫描灌注成像(CTP)的RAPID软件在行血管内治疗的前循环急性缺血性脑卒中患者预后预测中的应用价值,并探寻影响患者预后的指标。方法 回顾性分析2017年1月至2018年2月于海军军医大学(第二军医大学)长海医院行血管内治疗,完成脑CTP检查及RAPID软件进行后期图像分析,且术后血管再通达改良脑梗死溶栓(mTICI)2b级及以上的前循环急性缺血性脑卒中患者的病历资料。根据术后3个月改良Rankin量表(mRS)评分,将患者分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分>2分)。比较两组年龄、入院时美国国立卫生研究院卒中量表(NIHSS)评分等一般资料以及RAPID软件分析结果,包括达峰时间 >4 s、> 6 s、> 8 s、> 10 s的低灌注区体积(VTmax > 4 sVTmax > 6 sVTmax > 8 sVTmax > 10 s)和梗死核心区体积(VCBF < 30%)、脑血流不匹配体积和不匹配指数(MMR)。采用多因素logistic回归分析筛选预测因素,并获得预测公式。采用受试者工作特征(ROC)曲线评价该预测公式的预测能力。结果 符合入组标准的前循环急性缺血性脑卒中患者共137例,预后良好组92例,预后不良组45例。预后良好组患者的年龄、入院时NIHSS评分均低于预后不良组,差异均有统计学意义(t=-4.21、-4.06,P均<0.01)。预后良好组VTmax > 6 sVTmax > 8 sVTmax > 10 sVCBF < 30%均小于预后不良组,MMR大于预后不良组,差异均有统计学意义(Z=-3.11、-3.17、-3.38、-4.52、-3.74,P均<0.01)。Logistic回归分析显示年龄、VCBF < 30%小是大血管闭塞所致前循环急性缺血性脑卒中血管内治疗患者预后良好的影响因素[比值比(OR)=0.904,95%置信区间(CI):0.860~0.950;OR=0.976,95% CI:0.964~0.988;P均<0.01]。预测公式为Logit(P)=8.454-0.024×VCBF<30%-0.101×年龄。ROC曲线分析结果显示该预测公式的曲线下面积为0.786(95% CI:0.699~0.873,P<0.01)。结论 VCBF<30%和年龄是前循环急性缺血性脑卒中血管内治疗患者预后的独立预测因素,年龄越小、VCBF<30%越小预后良好的可能越大。基于CTP的RAPID软件可用于术前筛选适合血管内治疗的前循环急性缺血性脑卒中患者,值得临床推广。
关键词:  计算机断层扫描灌注成像  RAPID软件  血管内治疗  缺血性脑卒中  预后
DOI:10.16781/j.0258-879x.2018.09.1013
投稿时间:2018-07-30修订日期:2018-08-23
基金项目:上海市科委医学引导项目(124119a8900),上海市科技创新行动计划重点项目(14401970304).
Application of RAPID software in predicting prognosis of acute ischemic stroke patients with endovascular treatment
ZHANG Ping1,ZHANG Min-min1,YANG Peng-fei1,LU Jian-ping2,LIU Jian-min1*,ZHANG Yong-wei1,DENG Ben-qiang1*
(1. Stroke Center, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China;
2. Department of Medical Imaging, Changhai Hospital, Navy Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors)
Abstract:
Objective To explore the application value of RAPID software based on computed tomography perfusion (CTP) in predicting the outcome of anterior circulation acute ischemic stroke patients with endovascular therapy, and to investigate the indicators influencing prognosis of the patients. Methods A retrospective analysis was done on the clinical data of patients with anterior circulation acute ischemic stroke. All patients underwent endovascular treatment in Changhai Hospital of Navy Medical University (Second Military Medical University) between Jan. 2017 and Feb. 2018, completed cerebral CTP examination and had image analysis results by RAPID software, and the postoperative endovascular reperfusion achieved a modified thrombolysis in cerebral infarction (mTICI) grade ≥ 2b. According the modified Rankin scale (mRS) score at 3 months after surgery, the patients were divided into good prognosis (mRS score ≤ 2) and poor prognosis (mRS score>2) groups. The age, National Institutes of Health stroke scale (NIHSS) score on admission and the image analysis results by RAPID software, including the volumes of hypoperfusion of time to maximum > 4 s, > 6 s, > 8 s, > 10 s (VTmax > 4 s, VTmax > 6 s, VTmax > 8 s, VTmax > 10 s), core volume of necrosis (VCBF<30%), mismatch volume and the mismatch ratio (MMR), were compared between the two groups. Logistic regression analysis was used to investigate the prognostic predictors and obtain a prediction formula. Receiver operating characteristic (ROC) curve was used to evaluate the prediction value of the prediction formula. Results Totally 137 patients with anterior circulation acute ischemic stroke were included, including 92 patients in the good prognosis group and 45 in poor prognosis group. The age and NIHSS score on admission were significantly lower in the good prognosis group than those in the poor prognosis group (t=-4.21 and -4.06, both P<0.01). Compared with the poor prognosis group, the VTmax > 6 s, VTmax > 8 s, VTmax > 10 s and VCBF < 30% were significantly smaller, and the MMR was significantly lower in the good prognosis group (Z=-3.11, -3.17, -3.38, -4.52 and -3.74, all P<0.01). Logistic regression analysis showed that young and small VCBF<30% were independent predicting factors of good prognosis (odds ratio[OR]=0.904, 95% confidence interval[CI] 0.860-0.950; OR=0.976, 95% CI 0.964-0.988; both P<0.01). A prediction formula was obtained:Logit (P)=8.454-0.024×VCBF<30%-0.101×age, and the area under the ROC curve of the prediction formula was 0.786 (95% CI 0.699-0.873, P<0.01). Conclusion The age and VCBF<30% are independent factors influencing outcome of patients with anterior circulation acute ischemic stroke. RAPID software based on CTP can be used for preoperative screening of patients with anterior circulation acute ischemic stroke suitable for endovascular treatment, which is worthy of clinical promotion.
Key words:  computed tomography perfusion  RAPID software  endovascular treatment  ischemic stroke  prognosis