基于磁共振高分辨血管壁成像指标分析大脑中动脉狭窄性缺血性脑卒中患者预后的影响因素

doi:10.3760/cma.j.cn441417-20250115-12004

摘要/Abstract

摘要：

目的　基于磁共振高分辨血管壁成像指标探讨大脑中动脉（MCA）狭窄性缺血性脑卒中患者预后的影响因素。方法　采用回顾性研究，选取2020年1月至2024年5月徐州市第一人民医院收治的80例预后不良的MCA狭窄性缺血性脑卒中患者作为研究组（出院3个月后Rankin量表评分≤2分），男49例、女31例，年龄（58.54±9.54）岁；另纳入同期收治98例预后良好的MCA狭窄性缺血性脑卒中患者为对照组，男61例、女37例，年龄（60.01±10.67）岁。比较两组临床资料及磁共振高分辨血管壁成像指标，并予以多因素logistic回归分析法分析MCA狭窄性缺血性脑卒中患者预后不良的危险因素，构建回归方程，其预测价值通过绘制受试者操作特征曲线（ROC）进行分析，采用χ²检验、独立样本t检验进行统计比较。结果　研究组中，MCA重度狭窄～闭塞患者占比为75.00%（60/80），高于对照组的23.47%（23/98）；研究组格拉斯哥昏迷评分（GCS）低于对照组，美国国立卫生研究院脑卒中量表（NIHSS）评分高于对照组（均P<0.05）。研究组最狭窄处管腔面积小于对照组，T1加权成像（T1WI）信号强度指数、T2加权成像（T2WI）信号强度指数、斑块强化率、管壁标准化指数（NWI）高于对照组，血管总面积（TVA）、管壁面积（WA）大于对照组（均P<0.05）。多因素logistic回归分析结果显示，MCA重度狭窄～闭塞（OR=1.966）、NIHSS评分高（OR=2.784）、最狭窄处管腔面积小（OR=2.396）、T1WI信号强度指数高（OR=1.988）、T2WI信号强度指数高（OR=3.047）、NWI高（OR=1.721）、TVA大（OR=2.221）、WA大（OR=2.998）是MCA狭窄性缺血性脑卒中患者预后不良的独立危险因素（均P<0.05）。构建回归方程，按照诊断概率logit（P）绘制预测MCA狭窄性缺血性脑卒中患者预后不良ROC，当率logit（P）>11.73时，曲线下面积（AUC）及χ²值分别为0.872、13.596，95%CI为0.814～0.917，诊断灵敏度及特异度分别为85.00%、79.59%。结论　MCA重度狭窄～闭塞、最狭窄处管腔面积小、NIHSS评分高、T1WI信号强度指数高、T2WI信号强度指数高、NWI高、TVA大、WA大是MCA狭窄性缺血性脑卒中患者预后不良的独立危险因素，回归方程具有较高预测价值。

关键词: 磁共振, 高分辨血管壁成像, 大脑中动脉狭窄, 缺血性脑卒中, 预后, 影响因素

Abstract:

Objective　To explore the prognostic factors influencing the prognosis of patients with middle cerebral artery (MCA) stenosis (CIS) ischemic stroke based on high-resolution vascular wall imaging indicators using magnetic resonance imaging (MRI). Methods　This study was a retrospective study. Eighty patients with poor prognosis of MCA stenosis ischemic stroke admitted to Xuzhou First People's Hospital from January 2020 to May 2024 were selected as a study group (the score of Rankin scale ≤ 2 after discharge for 3 months); there were 49 males and 31 females; they were (58.54±9.54) years old. Another 98 patients with good prognosis of MCA stenosis ischemic stroke admitted during the same period were selected as a control group; there were 61 males and 37 females; they were (60.01±10.67) years old. The clinical data and MRI high-resolution vascular wall imaging indicators were compared between the two groups. The risk factors for the poor prognosis in the patients with MCA stenosis ischemic stroke were analyzed by the multiple logistic regression analysis. The regression equation was constructed, and a receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of the regression equation for the prognosis of the patients with MCA stenosis ischemic stroke. χ² and independent-sample t tests were used for the statistical comparisons. Results　The proportion of the patients with severe stenosis or occlusion of the MCA in the study group was higher than that in the control group [75.00% (60/80) vs. 23.47% (23/98); P<0.05].The score of Glasgow Coma Scale (GCS) in the study group was lower than that in the control group, and the score of National Institutes of Health Stroke Scale (NIHSS) of the United States was higher (both P<0.05). The narrowest lumen area in the study group was smaller than that in the control group (P<0.05); the T1 weighted imaging (T1WI) signal intensity index, T2 weighted imaging (T2WI) signal intensity index, plaque enhancement rate, and wall normalization index (NWI) in the study group were higher than those in the control group (all P<0.05); the total vascular area (TVA) and wall area (WA) in the study group were greater than those in the control group (both P<0.05). The results of multiple logistic regression analysis showed that severe stenosis or occlusion of the MCA (OR=1.966), a high score of NIHSS (OR=2.784), a small lumen area at the narrowest point (OR=2.396), a high T1WI signal intensity index (OR=1.988), a high T2WI signal intensity index (OR=3.047), a high NWI (OR=1.721), a large TVA (OR=2.221), and a large WA (OR=2.998) were independent risk factors for poor prognosis in the patients with MCA stenosis ischemic stroke (all P<0.05). The regression equation was constructed. According to the diagnostic probability logit (P), the ROC was drawn to predict the poor prognosis in the patients. When logit (P)>11.73, the area under the curve (AUC) and χ² value were 0.872 and 13.596, respectively, with a 95%CI of 0.814-0.917. The diagnostic sensitivity and specificity were 85.00% and 79.59%, respectively. Conclusions Severe stenosis or occlusion of the MCA, a small lumen area at the narrowest point, a high score of NIHSS, a high T1WI signal intensity index, a high T2WI signal intensity index, a high NWI, a large TVA, and a large WA are independent risk factors for poor prognosis in patients with MCA stenosis ischemic stroke. The regression equation has high predictive value.

Key words: Magnetic resonance, , High-resolution vascular wall imaging, , Middle cerebral artery stenosis, , Ischemic stroke, , Prognosis, , Influencing factors

张学勤曹伟孙向征王暖杨浩然. 基于磁共振高分辨血管壁成像指标分析大脑中动脉狭窄性缺血性脑卒中患者预后的影响因素 [J]. 国际医药卫生导报, 2025, 31(12): 1953-1958.

Zhang Xueqin, Cao Wei, Sun Xiangzheng, Wang Nuan, Yang Haoran.

Factors influencing prognosis of patients with middle cerebral artery stenosis ischemic stroke based on MRI high-resolution vascular wall imaging indicators [J]. International Medicine and Health Guidance News, 2025, 31(12): 1953-1958.

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