Page 106 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第42卷第5期
·702 · Journal of Nanjing Medical University（Natural Sciences） 2022年5月

·临床研究·

症状性颅内粥样硬化患者前循环低灌注与缺血性卒中复发相

关性的定量研究

任舒静，沈子祯，苏春秋，吴蓉蓉，施海彬，鲁珊珊，洪汛宁 *
南京医科大学第一附属医院放射科，江苏 南京 210029

［摘 要］ 目的：探讨症状性颅内动脉粥样硬化性疾病（intracranial atherosclerotic disease，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），基于残余功能达峰时间（time to maximum of the residual function，Tmax ）阈值Tmax>4 s及
Tmax>6 s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> 6 s及Tmax> 4 s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10 mL，95% CI：1.051~1.194，P＜0.001），ROC 曲线下面积为0.756（95% CI：0.672~0.839），灵敏度76.3%，特
异度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。
［关键词］ 缺血性卒中；磁共振成像；颅内动脉粥样硬化；灌注
［中图分类号］ R445.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2022）05⁃702⁃06
doi：10.7655/NYDXBNS20220516

The relationship between hypoperfusion distal to anterior circulation in symptomatic
intracranial atherosclerosis and ischemic stroke recurrence：a quantitative study

REN Shujing，SHEN Zizhen，SU Chunqiu，WU Rongrong，SHI Haibin，LU Shanshan，HONG Xunning *
Department of Radiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：This study aims 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 initial group，with
the first episode of acute and subacute ischemic stroke/transient ischemic attack（TIA）（n=92）；and recurrent group，with recurrent
acute ischemic stroke/TIA（n=38）. Hypoperfusion was assessed quantitatively based on time threshold of T max>4 s and Tmax>6 s. The
degree of stenosis，border zone infarction（BZI）and hypoperfusion volume of T max>6 s and Tmax>4 s 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 T max>4 s and Tmax>6 s（both P＜0.001）were found in recurrent group
compared to initial group. Multivariable logistic regression showed that hypoperfusion volume defined by T max>4 s was the only
independent imaging marker that associated with stroke recurrence（OR=1.120，per 10 mL 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 T max>4 s was independently associated with recurrent ischemic stroke，and thus may

［基金项目］ 国家自然科学基金面上项目资助（82171907）
∗
通信作者（Corresponding author），E⁃mail： hongxunning@sina.com