CT灌注参数联合D-二聚体对急性缺血性脑卒中溶栓后出血转化的预测价值

The Predictive Value of CT Perfusion Parameters Combined with D-Dimer in Hemorrhagic Transformation after Thrombolysis in Acute Ischemic Stroke

摘要: 目的：探讨CT灌注参数联合D-二聚体(D-Dimer, D-D)对急性缺血性脑卒中患者静脉溶栓后出血转化的预测价值。方法：选取2021年6月~2023年6月于华北理工大学附属医院神经重症病房进行静脉溶栓的急性缺血性脑卒中的85位患者作为本次的研究对象。所有患者均于发病后1.0~4.5 h内来院就诊，在6 h以内进行溶栓治疗，于溶栓后24 h内行CT灌注检查。根据患者7 d后CT检查是否发生出血，分为出血组和未出血组。同时记录两组患者临床资料、血清D-二聚体水平以及CT灌注主要参数，将所得数据进行Logistic回归分析，并绘制ROC曲线，分析CT灌注参数联合D-二聚体对急性缺血性脑卒中患者静脉溶栓后发生出血转化的预测价值。结果：溶栓后共有24位患者发生出血转化，出血率为28.24%。出血组患者NIHSS评分及血清D-二聚体水平较未出血组升高(P < 0.05)；出血组患者的脑血容量(CBV)和脑血流量(CBF)较未出血组呈明显下降趋势(P < 0.05)；出血组患者的达峰时间(TTP)较未出血组呈上升趋势(P < 0.05)；进行多因素Logistic回归分析，结果显示，CBV (OR = 0.199)、CBF (OR = 0.883)、TTP (OR = 1.214)及D-二聚体(OR = 1.006)为发生出血转化的独立危险因素。ROC曲线结果提示，相较于其他灌注参数，CBF的AUC值最大，为0.761，其敏感度为75.0%，特异度26.2%。当CBV及D-二聚体联合出现时，敏感性及特异性略有上升。结论：CT灌注参数CBF及血清D-二聚体水平对急性缺血性脑卒中患者静脉溶栓后是否发生出血转化具有较高的预测价值。

Abstract: Objective: To investigate the predictive value of CT perfusion parameters combined with D-dimer (D-D) in hemorrhagic transformation after intravenous thrombolysis in patients with acute ischem-ic stroke. Methods: A total of 85 patients with acute ischemic stroke who underwent intravenous thrombolysis in the Neurological Intensive Care Unit of the Affiliated Hospital of North China Uni-versity of Science and Technology from June 2021 to June 2023 were enrolled as the subjects of this study. All patients came to the hospital within 1.0~4.5 hours after the onset of the disease, and thrombolytic therapy was performed within 6 hours, and CT perfusion examination was performed within 24 hours after thrombolysis. According to whether the patients had bleeding on CT examina-tion after 7 days, they were divided into bleeding group and non-bleeding group. At the same time, the clinical data, serum D-dimer level and main parameters of CT perfusion were recorded in the two groups, and the obtained data were analyzed by logistic regression analysis, and ROC curves were plotted to analyze the predictive value of CT perfusion parameters combined with D-dimer for hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke. Results: A total of 24 patients underwent hemorrhagic transformation after thrombolysis, and the bleeding rate was 28.24%. The NIHSS score and serum D-dimer level in the bleeding group were higher than those in the non-bleeding group (P < 0.05), the cerebral blood volume (CBV) and cere-bral blood flow (CBF) in the bleeding group decreased significantly compared with the non-bleeding group (P < 0.05), and the time to peak (TTP) in the bleeding group was higher than that in the non-bleeding group (P < 0.05). Multivariate logistic regression analysis showed that CBV (OR = 0.199), CBF (OR = 0.883), TTP (OR = 1.214), and D-dimer (OR = 1.006) were independent risk fac-tors for hemorrhagic transformation. The results of ROC curve showed that compared with other perfusion parameters, CBF had the highest AUC value of 0.761, a sensitivity of 75.0%, and a speci-ficity of 26.2%. When CBV and D-dimer are combined, sensitivity and specificity increase slightly. Conclusion: CT perfusion parameters CBF and serum D-dimer levels have high predictive value for hemorrhagic transformation after intravenous thrombolysis in patients with acute ischemic stroke.