缺血性脑卒中患者CT灌注成像参数与认知功能评分的关系OA
Association Between CT Perfusion Imaging Parameters and Cognitive Function Scores in Patients with Ischemic Stroke
目的 探讨缺血性脑卒中患者CT灌注成像参数与认知功能评分的关系.方法 回顾性选取2022年9月至2025年2月绵阳四〇四医院收治的急性缺血性脑卒中患者480例.所有患者于入院时完成头颅CT灌注成像检查,根据3个月随访时蒙特利尔认知评估量表(MoCA)评分将患者分为认知功能障碍组(188例,0～25分)与认知正常组(292例,26～30分).比较两组患者入院时CT灌注成像参数[患侧半球的脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)]、3个月后血清神经损伤标志物[神经丝轻链蛋白(NfL)、神经元特异性烯醇化酶(NSE)]、血管性认知障碍标志物[同型半胱氨酸(Hcy)、S100β蛋白、脑源性神经营养因子(BDNF)]水平;ROC曲线评估CT灌注成像参数对脑卒中后认知功能障碍的预测效能;采用Pearson相关系数分析认知功能障碍患者入院时头颅CT灌注参数水平与MoCA评分、血清神经损伤标志物、血管性认知障碍标志物的相关性.结果 认知功能障碍组CBF、CBV、BDNF水平低于认知正常组,而MTT、NfL、NSE、Hcy、S100β蛋白水平高于认知正常组(P<0.05);ROC曲线显示,CBF、CBV、MTT及其联合对脑卒中后认知功能障碍的曲线下面积(AUC)分别为0.831、0.740、0.886、0.911(P<0.05);Pearson分析显示,CBF、CBV与MoCA评分、BDNF呈正相关,与NfL、NSE、Hcy、S100β蛋白呈负相关(P<0.05);MTT与MoCA评分、BDNF呈负相关,与NfL、NSE、Hcy、S100β蛋白呈正相关(P<0.05).结论 急性缺血性脑卒中患者入院CT灌注参数与3个月后认知功能及血清生物标志物存在显著关联.MTT、CBF等参数对卒中后认知障碍具有良好的预测价值.
Objective To investigate the relationship between CT perfusion imaging parameters and cognitive function scores in patients with ischemic stroke.Methods The clinical data of 480 patients with acute ischemic stroke admitted to the Department of Cerebrovascular Medicine at Mianyang 404 Hospital from September 2022 to February 2025 were retrospectively analyzed.All patients underwent cranial CT perfusion imaging on admission.Based on the Montreal Cognitive Assessment(MoCA)score at the 3-month follow-up,patients were divided into a cognitive impairment group(188 cases,MoCA score 0-25)and a cognitively normal group(292 cases,MoCA score 26-30).CT perfusion imaging parameters[cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT)]in the affected hemisphere on admission,and the levels of serum neuronal injury markers[neurofilament light chain(NfL),neuron-specific enolase(NSE)]and vascular cognitive impairment markers[homocysteine(Hcy),S100β protein,brain-derived neurotrophic factor(BDNF)]at 3 months were compared between the two groups.ROC curve analysis was used to evaluate the predictive efficacy of CT perfusion imaging parameters for post-stroke cognitive impairment.Pearson correlation analysis was used to analyze the correlations between admission CT perfusion parameters and MoCA scores,serum neuronal injury markers,and vascular cognitive impairment markers in patients with cognitive impairment.Results The levels of CBF,CBV,and BDNF in the cognitive impairment group were lower than those in the cognitively normal group,while the levels of MTT,NfL,NSE,Hcy,and S100β protein were higher(P<0.05).ROC curve analysis showed that the areas under the curve for CBF,CBV,MTT,and their combination in predicting post-stroke cognitive impairment were 0.831,0.740,0.886,and 0.911,respectively(P<0.05).Pearson analysis revealed that CBF and CBV were positively correlated with MoCA score and BDNF,and negatively correlated with NfL,NSE,Hcy,and S100β protein;whereas MTT was negatively correlated with MoCA score and BDNF,and positively correlated with NfL,NSE,Hcy,and S100β protein(P<0.05).Conclusion CT perfusion parameters on admission in patients with acute ischemic stroke show significant associations with cognitive function and serum biomarkers at 3 months.Parameters such as MTT and CBF have good predictive value for post-stroke cognitive impairment.
杨阳;何志明;孙雷;王元鹏;黄敏;罗军;杨芝芝
绵阳四〇四医院医学影像科,四川 绵阳 621000绵阳四〇四医院医学影像科,四川 绵阳 621000绵阳四〇四医院医学影像科,四川 绵阳 621000绵阳四〇四医院医学影像科,四川 绵阳 621000绵阳四〇四医院医学影像科,四川 绵阳 621000绵阳四〇四医院脑血管科,四川 绵阳 621000绵阳四〇四医院检验科,四川 绵阳 621000
缺血性脑卒中CT灌注成像参数认知功能评分ROC曲线
ischemic strokeCT perfusion imaging parameterscognitive function scoresROC curve
《转化医学杂志》 2026 (4)
594-599,6
四川省卫生和计划生育委员会科研课题项目(18PJ337)
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