颅脑双源CTP参数联合血清P2X7R、NRG-1对重度急性脑梗死病情的诊断价值OA
Diagnostic value of combining dual-source computed tomography perfusion parameters of the brain with serum P2X7R and NRG-1 for severe acute cerebral infarction
目的 探讨颅脑双源计算机断层灌注成像(CTP)参数联合血清嘌呤能 2X7 受体(P2X7R)、神经调节蛋白-1(NRG-1)对重度急性脑梗死(ACI)的诊断价值.方法 选取 2023 年 1 月—2025 年 3 月华北医疗健康集团峰峰总医院收治的165 例ACI 患者(观察组),根据美国国立卫生研究院卒中量表(NIHSS)评分分为轻度61 例、中度54 例、重度50 例.同期另选取体检健康的志愿者165 例(对照组).所有 ACI 患者于发病24 h 内行颅脑双源CTP 检查,获取脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP);并于入院次日采集空腹静脉血,ELISA 法检测血清 P2X7R、NRG-1.比较各组临床资料及实验室指标;多因素Logistic 回归分析重度 ACI 的影响因素.绘制受试者工作特征(ROC)曲线评估各指标及联合模型对重度 ACI的诊断效能.结果 观察组血清 P2X7R、NRG-1 水平均高于对照组,差异具有统计学意义(P<0.05).轻度ACI 组、中度 ACI 组、重度 ACI 组吸烟史占比、TTP、MTT、P2X7R、NRG-1 水平依次升高,CBF、CBV 依次降低,差异均具有统计学意义(P<0.05);高 TTP、MTT、P2X7R、NRG-1 均为重度 ACI 的独立危险因素(P<0.05),而高 CBF、CBV 则为其独立保护因素(P<0.05);CBF、CBV、TTP、MTT、P2X7R、NRG-1 水平单独诊断重度 ACI的曲线下面积(AUC)分别为0.807、0.809、0.819、0.785、0.844、0.823,联合诊断的 AUC 为0.951,优于单独诊断(ZCBF-联合=4.124、ZCBV-联合=4.063、ZTTP-联合=3.253、ZMTT-联合=3.311、ZP2X7R-联合=2.902、ZNRG-1-联合=2.951,P 均<0.05).结论 血清 P2X7R、NRG-1 水平及双源 CTP 定量参数与 ACI 病情程度密切相关,二者联合可显著提高对重度 ACI 的诊断效能,具有重要临床应用价值.
Objective To explore the diagnostic value of dual source computed tomography perfusion(CTP)combined with serum purinergic 2X7R receptor(P2X7R)and neuregulin-1(NRG-1)for the severity of acute cerebral infarction(ACI).Methods One hundred and sixty-five ACI patients admitted to Fengfeng General Hospital,North China Medical Health Group from January 2023 to March 2025 were selected as the observation group.National Institute of Health stroke scale(NIHSS)scores,ACI patients were assigned into mild ACI group(n=61),moderate ACI group(n=54),and severe ACI group(n=50).Meanwhile,another 165 healthy individuals who underwent physical check-ups were considered as the control group(NC group).All ACI patients underwent dual-source CTP examination of the brain within 24 hours of onset to obtain cerebral blood flow(CBF),cerebral blood volume(CBV),mean transit time(MTT),and time to peak(TTP).Fasting venous blood was collected on the second day after admission,and serum P2X7R and NRG-1 were detected by ELISA.The clinical data and laboratory indicators of each group were compared.Multivariate logistic regression analysis was conducted to investigate the influencing factors of severe ACI.ROC curve was used to evaluate the diagnostic performance of each indicator and the combined model for severe ACI.Results Compared with the NC group,the ACI group had prominently higher serum P2X7R and NRG-1(P<0.05).The proportion of smoking history,TTP,MTT,P2X7R,and NRG-1 sequentially prominently increased in the mild ACI group,moderate ACI group,and severe ACI group,while CBF and CBV sequentially prominently decreased(P<0.05).High CBF and CBV were independent protective factors affecting the severity of ACI,while high TTP,MTT,P2X7R,and NRG-1 were independent risk factors(P<0.05).The area under curve(AUC)for the individual diagnosis of severe ACI based on CBF,CBV,TTP,MTT,P2X7R,and NRG-1 levels was 0.807,0.809,0.819,0.785,0.844,and 0.823,respectively.The AUC for combined diagnosis was 0.951,which was superior to individual diagnosis(ZCBF-combination=4.124,ZCBV-combination=4.063,ZTTP-combination=3.253,ZMTT-combination=3.311,ZP2X7R-combination=2.902,ZNRG-1-combination=2.951,all P<0.05).Conclusions The levels of serum P2X7R and NRG-1,as well as the quantitative parameters of dual-source CTP,are closely related to the severity of ACI.The combination of the two can significantly enhance the diagnostic efficacy for severe ACI and holds significant clinical application value.
于欣欣;李珑;王雪皎;王超;申真;赵姗姗
056200 邯郸,华北医疗健康集团峰峰总医院放射影像科056200 邯郸,华北医疗健康集团峰峰总医院放射影像科056200 邯郸,华北医疗健康集团峰峰总医院神经内科056200 邯郸,华北医疗健康集团峰峰总医院放射影像科056200 邯郸,华北医疗健康集团峰峰总医院神经内科056200 邯郸,华北医疗健康集团峰峰总医院神经内科
医药卫生
双源 CT 灌注成像急性脑梗死嘌呤能2X7 受体神经调节蛋白-1诊断价值
dual source computed tomography perfusionacute cerebral infarctionpurinergic 2X7 receptorneuregulin-1diagnostic value
《临床神经外科杂志》 2026 (4)
373-379,7
邯郸市科学技术研究与发展计划项目(23422083383)
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