目的：探讨症状性颅内动脉粥样硬化（ICAD）患者前循环低灌注与缺血性卒中复发的相关性。方法：回顾性分析130例由大脑中动脉狭窄引发的症状性ICAD患者，根据急性缺血性卒中事件发生次数将其分为初发组（n=92）和复发组 (n=38)，基于时间阈值Tmax>4 s及Tmax>6s定量低灌注体积。采用独立样本t检验、非参数检验、卡方检验或Fisher精确概率法对比分析两组患者大脑中动脉狭窄率、分水岭梗死发生率、Tmax > 6s及Tmax > 4s的低灌注体积，多因素Logistic回归探讨缺血性卒中复发相关的独立危险因素，并进行ROC曲线分析。结果：与初发组相比，复发组血管狭窄率更高（P=0.003）、分水岭梗死发生比例更高（P=0.037）、Tmax>6 s及Tmax>4 s 的低灌注体积更高（P值均＜0.001），其中Tmax>4 s的低灌注体积是与缺血性卒中复发相关的独立危险因素（OR=1.120，低灌注体积每增加10ml，95% CI：1.051-1.194，P＜0.001），ROC曲线下面积为0.756（95% CI：0.672-0.839），敏感性76.3%，特异性63.0%。结论：基于时间阈值Tmax>4 s量化的低灌注体积，是前循环症状性ICAD患者卒中复发的独立危险因素，可能成为预警缺血性卒中复发的有效影像学标志物。
Purpose: To investigate the relationship between hypoperfusion distal to anterior circulation in symptomatic intracranial atherosclerotic disease (ICAD) patients and recurrent ischemic stroke. Methods: One hundred and thirty symptomatic patients caused by middle cerebral artery stenosis were retrospectively analyzed. They were divided into group 1, with the first episode of acute and subacute ischemic stroke/transient ischemic attack(TIA)（n=92）；and group 2，with recurrent acute ischemic stroke/TIA（n=38）. Hypoperfusion was assessed quantitatively based on time threshold of Tmax>4s and Tmax>6s. The degree of stenosis, border zone infarction (BZI) and hypoperfusion volume of Tmax >6s and Tmax >4s were measured and compared between groups using independent sample t test, non-parametric test，chi?square or fisher’s exact test as appropriate. Logistic regression model was constructed to investigate the risk factors for recurrent stroke. Receiver operating characteristic curve analysis was used to determine the diagnostic performance of the parameters. Results: Higher degree of stenosis（P=0.003）, more BZI pattern (P=0.037) and higher hypoperfusion volume defined by both Tmax>4s and Tmax>6s (both P＜0.001) were found in group 2 compared to group 1. Multivariable logistic regression showed that hypoperfusion volume defined by Tmax>4s was the only independent imaging marker that associated with stroke recurrence (OR=1.120, per 10ml_increase, 95% CI: 1.051-1.194，P<0.001). The area under the ROC curve was 0.756 (95%CI: 0.672-0.839), with a sensitivity of 76.3% and a specificity of 63.0%. Conclusion: Higher volume of distal hypoperfusion defined by Tmax>4s was independently associated with recurrent ischemic stroke, and thus may be a useful imaging marker for stratifying the risk of stroke recurrence in symptomatic ICAD patients.