急性脑梗死患者CT低密度征与血清NSE水平的相关性及其对神经功能预后的预测价值研究OA
Association between Cranial CT Hypodensity Signs and Serum Neuron-specific Enolase Levels in Acute Cerebral Infarction and Their Predictive Value for Neurological Prognosis
目的:探讨急性脑梗死(acute cerebral infarction,ACI)患者头颅CT低密度征与血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平的相关性,并评估二者与相对脑血流量(rela-tive cerebral blood flow,rCBF)联合对短期神经功能预后的预测价值.方法:采用前瞻性观察性研究,纳入2022年1月至2023年6月住院确诊的ACI患者126例.所有患者于入院24小时内完成非增强CT与CT灌注检查并测定血清NSE.低密度征依据非增强CT的早期缺血性改变进行分级评分(总分0～10分,标准见正文方法学),并评估ASPECTS与梗死体积;CTP提取灌注参数,预先设定rCBF为核心分析指标.依据第7天NIHSS较入院时的改善情况分为良好预后组(n=52)与不良预后组(n=74),采用Spearman分析相关性;以单因素筛选结合临床意义纳入多因素Logistic回归;以ROC及DeLong检验评价预测效能.结果:与良好预后组相比,不良预后组NSE水平显著升高(38.73±7.22 vs.24.26±6.77 ng/mL,P＜0.001),低密度征评分与梗死体积更高、rCBF更低(均P＜0.001).NSE与低密度征评分呈正相关(r=0.613),与rCBF呈负相关(r=-0.564)(均P＜0.001).多因素分析显示,低密度征评分(OR=2.703,95％CI:1.403～5.206,P=0.003)、NSE(OR=1.133,95％CI:1.070～1.200,P＜0.001)及 rCBF(OR=0.089,95％CI:0.017～0.471,P=0.005)与不良短期预后独立相关.ROC分析显示,NSE、低密度征评分与rCBF的AUC 分别为 0.851、0.807和 0.826;三者联合模型 AUC 为 0.923(95％CI:0.867～0.965),敏感度88.11％、特异度83.33％,DeLong检验P=0.010,优于任一单项指标.结论:在入院早期评估中,CT低密度征评分、rCBF与血清NSE与ACI患者的短期神经功能结局均有关联;三者联合能够提升判别能力,为24小时内的风险分层与早期干预提供潜在参考.上述结论仍需在更大样本与外部队列中进一步验证.
Objective:To examine the correlation between cranial non-contrast CT hypodensity score and serum neuron-specific enolase(NSE)in patients with acute cerebral infarction(ACI),and to evaluate the prognostic performance of combining these measures with relative cerebral blood flow(rCBF)for short-term neurological outcomes.Methods:In this prospective observational study,126 hospitalized ACI patients were enrolled between January 2022 and June 2023.Within 24 hours of admission,all patients underwent non-contrast CT and CT perfusion(CTP)and had serum NSE measured.CT hypodensity was graded as an early ischemic change-based score on non-contrast CT(total 0～10;criteria detailed in Methods).ASPECTS and infarct volume were assessed;CTP parameters were derived with rCBF pre-specified as the core perfusion metric.Patients were categorized by improvement in the NIHSS score on day 7 relative to admission into favorable(n=52)and unfavorable(n=74)prognosis groups.Spearman correlation assessed associations;variables from univariate analysis together with clinically important covariates entered multivariable logistic regression.Discrimination was evaluated by ROC curves with DeLong's test.Results:Compared with the favorable group,the unfavorable group showed higher NSE(38.73±7.22 vs.24.26±6.77 ng/mL,P＜0.001),higher hypodensity scores and infarct volumes,and lower rCBF(all P＜0.001).NSE correlated positively with the hypodensity score(r=0.613)and negatively with rCBF(r=-0.564)(both P＜0.001).In multivariable models,hypodensity score(OR=2.703,95％CI:1.403～5.206,P=0.003),NSE(OR=1.133,95％CI:1.070～1.200,P＜0.001),and rCBF(OR=0.089,95％CI:0.017～0.471,P=0.005)remained independently associated with unfavorable short-term outcome.ROC analyses yielded AUCs of 0.851(NSE),0.807(hypodensity score),and 0.826(rCBF);the combined model achieved an AUC of 0.923(95％CI:0.867～0.965),with 88.11％sensitivity and 83.33％specificity,significantly outperforming any single indicator(DeLong P=0.010).Conclusion:Early assessment integrating CT hypodensity score,rCBF,and serum NSE is associated with short-term neurological outcomes in ACI.Their combination improves discrimination and may inform within-24-hour risk stratification and early management.External validation in larger,independent cohorts is warranted.
洪前梅;陈春梅;陈浪
达州市中心医院神经内科,四川 635002达州市中心医院神经内科,四川 635002达州市中心医院神经内科,四川 635002
医药卫生
急性脑梗死计算机断层成像神经元特异性烯醇化酶神经功能缺损预后
acute cerebral infarctioncomputed tomographyneuron-specific enolaseneurological deficitprognosis
《影像科学与光化学》 2026 (6)
25-32,8
四川省医学(青年创新)科研课题(S23001).
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