CTP成像对重度颈动脉狭窄患者保守治疗反应性的评估价值
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(1.张家口市第一医院神经内一科,河北省张家口市 075000;2.衡水市中医医院影像科,河北省衡水市 053000;3.三河燕郊福合第一医院神经内科,河北省三河市 065300)

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刘冬,主治医师,研究方向为重度颈动脉狭窄的治疗,E-mail:liudongdc90@163.com。

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河北省医学科学研究课题计划项目(20221509)


The evaluation value of CTP imaging for conservative treatment response in patients with severe carotid stenosis
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1.Department of Neurology, Zhangjiakou First Hospital, Zhangjiakou, Hebei 075000, China;2.Department of Imaging, Hengshui Hospital of Traditional Chinese Medicine, Hengshui, Hebei 053000, China;3.Department of Neurology, Sanhe Yanjiao Fuhe First Hospital, Sanhe, Hebei 065300, China)

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    摘要:

    目的]探讨颅脑CT灌注(CTP)成像对重度颈动脉狭窄(CAS)患者保守治疗的反应性评估价值。 [方法]选取重度CAS患者90例作为研究对象,均接受保守治疗,根据1年内是否出现脑缺血性疾病分为低反应组和高反应组。对比两组局部脑血容量(rCBV)、局部脑血流量(rCBF)、局部平均通过时间(rMTT)、局部达峰时间(rTTP),采用Cox回归模型分析保守治疗反应性的独立危险因素,列线图分析rCBV、rCBF、rTTP、rMTT对保守治疗反应性的评估价值,并进行决策曲线及临床影响曲线验证。 [结果]随访1年,90例重度CAS患者脱落2例,有效随访88例,未发生脑缺血相关并发症65例(高反应组),发生脑缺血性疾病23例(低反应组),其中短暂性脑缺血发作15例(17.05%),脑梗死8例(9.09%);治疗3个月,两组rCBF大于治疗前,rMTT、rTTP小于治疗前(P<0.05);治疗前和治疗3个月,低反应组rCBF小于高反应组,rMTT、rTTP大于高反应组(P<0.05);应用Cox回归模型筛选出的收缩压、尿酸、rCBF、rMTT、rTTP构建重度CAS患者保守治疗反应性列线图预测模型,一致性指数为0.896;校正曲线分析显示,预测模型预测保守治疗反应性与实际保守治疗反应性吻合度较高;在阈值为0.16~0.95范围内,列线图模型联合评估重度CAS患者保守治疗反应性的净受益率优于单独检测;在阈值概率为0.41时,被联合检测方案划分为高风险的人数与真阳性例数基本达到一致。 [结论]CTP成像参数与重度CAS患者治疗反应性关系密切,可为临床早期评估治疗反应性提供参考,有助于确保患者获益。

    Abstract:

    Aim To investigate the value of cranial computed tomography perfusion (CTP) imaging in evaluating conservative treatment response in patients with severe carotid artery stenosis (CAS). Methods A total of 90 patients with severe CAS were selected as the research subjects, all received conservative treatment, and they were divided into low response group and high response group according to whether cerebral ischemic disease occurred within 1 year. Regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), regional mean transit time (rMTT), and regional time to peak (rTTP) were compared between the two groups. Cox regression model was used to analyze the independent risk factors of conservative treatment responsiveness, and nomogram was used to analyze the value of rCBV, rCBF, rTTP and rMTT in evaluating conservative treatment responsiveness, and the decision curve and clinical impact curve were verified. Results Of the 90 patients with severe CAS, 2 cases dropped out after 1 year of follow-up, and 88 cases were effectively followed up. There were 65 cases without cerebral ischemia-related complications (in the high response group) and 23 cases with cerebral ischemic diseases (in the low response group), including 15 cases of transient ischemic attacks (17.05%) and 8 cases of cerebral infarction (9.09%). After 3 months of treatment, the rCBF in the two groups was greater than that before treatment, and the rMTT and rTTP were lower than those before treatment (P<0.05). Before treatment and 3 months after treatment, the rCBF of the low response group was lower than that of the high response group, and the rMTT and rTTP of the high response group were higher than those of the high response group (P<0.05). The Cox regression model was used to screen out systolic blood pressure, uric acid, rCBF, rMTT and rTTP, and construct a nomogram prediction model for conservative treatment response in patients with severe CAS. The consistency index was 0.896. Calibration curve analysis showed that the prediction model predicted conservative treatment response was in good agreement with the actual conservative treatment response. Within a threshold range of 0.16 to 0.95, the net benefit rate of the combined nomogram model in assessing responsiveness to conservative treatment in patients with severe CAS was superior to testing alone. The number of people classified as high risk by the joint detection scheme and the number of true positive cases were basically the same when the threshold probability was 0.41. Conclusion CTP imaging parameters are closely related to treatment responsiveness in patients with severe CAS, and they can provide a reference for early clinical evaluation of treatment responsiveness and help ensure patient benefit.

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刘冬,张慎和,郭菲. CTP成像对重度颈动脉狭窄患者保守治疗反应性的评估价值[J].中国动脉硬化杂志,2023,(10):872~878.

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  • 收稿日期:2022-11-08
  • 最后修改日期:2023-09-22
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  • 在线发布日期: 2023-11-08