黑龙江医药科学

目的:探讨动脉自旋标记成像(ASL)联合磁敏感加权血管成像(SWAN)对急性期缺血性脑卒中患者出血转化及预后的预测价值。方法:选取2024年2月至2024年12月于河南科技大学第二附属医院就诊的急性期缺血性脑卒中患者82例，根据是否发生出血转化分为出血转化组和非出血转化组，收集患者的临床资料，比较ASL和SWAN相关参数，采用多因素Logistic回归分析出血转化的影响因素，采用受试者工作特征(ROC)曲线分析ASL联合SWAN对出血转化的预测价值;对患者进行随访，根据改良Rankin量表评估预后，并分为预后不良组和预后良好组，采用多因素Logistic回归分析影响预后的因素，采用ROC曲线分析ASL联合SWAN对预后的预测价值。结果:82例患者中出血转化发生率为28.05%(23/82)，出血转化组年龄、入院NIHSS评分、糖尿病占比均高于非出血转化组(P<0.05);出血转化组患者CBF值低于非出血转化组，CMBs病灶数与非出血转化组比较差异有统计学意义(P<0.05);年龄、入院NIHSS评分、糖尿病、CBF、CMBs病灶是急性期缺血性脑卒中患者发生出血转化的影响因素(P<0.05); CBF联合CMBs病灶预测患者出血转化的曲线下面积(AUC)为0.847，高于各指标单独预测;随访发现，82例患者中预后不良率为34.15%(28/82)，预后不良组年龄、入院NIHSS评分高于预后良好组(P<0.05);预后不良组患者CBF值低于预后良好组，CMBs病灶数与预后良好组比较差异有统计学意义(P<0.05);年龄、入院NIHSS评分、CBF、CMBs病灶是急性期缺血性脑卒中患者预后不良的影响因素(P<0.05); CBF联合CMBs病灶预测患者预后不良的AUC为0.878，高于各指标单独预测。结论:ASL联合SWAN预测急性期缺血性脑卒中患者出血转化及预后具有一定价值，CBF、CMBs病灶是影响患者预后的重要因素。

Objective: To investigate the predictive value of arterial spin labeling( ASL) combined with susceptibility-weighted angiography( SWAN) for hemorrhagic transformation and prognosis in patients with acute ischemic stroke. Methods: 82 patients with acute ischemic stroke admitted to the Second Affiliated Hospital of Henan University of Science and Technology from February 2024 to December 2024 were selected. They were divided into a hemorrhagic transformation group and a non-hemorrhagic transformation group according to the occurrence of hemorrhagic transformation. Clinical data of the patients were collected,and relevant parameters of ASL and SWAN were compared. Multivariate Logistic regression analysis was used to identify the influencing factors for hemorrhagic transformation. The receiver operating characteristic( ROC) curve was used to analyze the predictive value of ASL combined with SWAN for hemorrhagic transformation. Patients were followed up,and their prognosis was evaluated using the modified Rankin Scale and they were divided into a poor prognosis group and a good prognosis group. Multivariate Logistic regression analysis was used to identify the factors influencing prognosis,and the ROC curve was used to analyze the predictive value of ASL combined with SWAN for prognosis. Results: Among the 82 patients,the incidence of hemorrhagic transformation was 28. 05%( 23/82). The age,admission NIHSS score and proportion of diabetes in the hemorrhagic transformation group were higher than those in the non-hemorrhagic transformation group( P < 0. 05). The cerebral blood flow( CBF) value in the hemorrhagic transformation group was lower than that in the non-hemorrhagic transformation group,and there was a significant difference in the number of cerebral microbleeds( CMBs) lesions between the two groups( P < 0. 05). Age,admission NIHSS score,diabetes,CBF and CMBs lesions were influencing factors for hemorrhagic transformation in patients with acute ischemic stroke( P < 0. 05). The area under the curve( AUC) for predicting hemorrhagic transformation by combining CBF with CMBs lesions was 0. 847,which was higher than that predicted by each index alone. During the follow-up,it was found that the poor prognosis rate among the 82 patients was 34. 15%( 28/82). The age and admission NIHSS score in the poor prognosis group were higher than those in the good prognosis group( P <0. 05). The CBF value in the poor prognosis group was lower than that in the good prognosis group,and there was a significant difference in the number of CMBs lesions between the two groups( P < 0. 05). Age,admission NIHSS score,CBF and CMBs lesions were influencing factors for poor prognosis in patients with acute ischemic stroke( P < 0. 05). The AUC for predicting poor prognosis by combining CBF with CMBs lesions was 0. 878,which was higher than that predicted by each index alone. Conclusion: ASL combined with SWAN has certain value in predicting hemorrhagic transformation and prognosis in patients with acute ischemic stroke. CBF and CMBs lesions are important factors affecting patient prognosis.