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目的 分析多模态CT成像与老年急性缺血性脑卒中患者神经功能的关系及其对脑卒中复发事件的预测效能。方法 回顾性选取2021年1月至2023年12月长沙市第一医院治疗的老年急性缺血性脑卒中患者160例，根据脑卒中复发事件发生情况分为复发组28例和未复发组132例。收集一般临床资料。采用ROC曲线评估多模态CT成像参数及美国国立卫生研究所卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分预测脑卒中复发的效能。结果 复发组尿酸、白细胞介素6、NIHSS评分、平均通过时间（mean transit time,MTT）、达峰时间（time to peak,TTP）明显高于未复发组，脑血容量（cerebral blood volume,CBV）、脑血流量（cerebral blood flow,CBF）、血管介入治疗比例明显低于未复发组（P<0.05,P<0.01），两组脑梗死严重程度、颅内大血管狭窄程度比较，差异有统计学意义（P<0.05,P<0.01）。老年急性缺血性脑卒中患者MTT、TTP与NIHSS评分呈正相关（r=0.671,r=0.704,P<0.05）,CBV、CBF与NIHSS评分呈负相关（r=-0.546、r=-0.667,P<0.05）。多因素logistic分析显示，NIHSS评分、MTT、TTP、CBV、CBF、颅内大血管狭窄程度为脑卒中复发事件的独立影响因素（P<0.05,P<0.01）。ROC曲线分析显示，MTT、TTP、CBV、CBF预测脑卒中复发的曲线下面积明显低于多模态CT成像四项参数联合，多模态CT成像参数、NIHSS评分的曲线下面积明显低于二者联合检测（P<0.01）。结论 多模态CT成像参数与老年急性缺血性脑卒中患者神经功能密切相关，且多模态CT成像参数及NIHSS评分联合检测对脑卒中复发事件具有较高的预测价值。
Abstract：Objective To analyze the relationship between multimodal CT imaging and neurological function in elderly patients with acute ischemic stroke(AIS) and its predictive efficacy for stroke recurrence events. Methods A total of 160 elderly AIS patients admitted in our hospital from January 2021 to December 2023 were retrospectively recruited, and based on the occurrence of stroke recurrence events or not, they were divided into a recurrence group(28 cases) and a non-recurrence group(132 cases). General clinical data were collected in all the patients. ROC curve was plotted to evaluate the efficacy of the parameters from multimodal CT imaging and the National Institutes of Health Stroke Scale(NIHSS) score in predicting stroke recurrence. Results The recurrence group had significantly higher uric acid and IL-6 levels, increased NIHSS score, longer mean transit time(MTT) and time to peak(TTP), and obviously lower cerebral blood volume(CBV) and cerebral blood flow(CBF) as well as decreased ratio of endovascular intervention when compared to the non-recurrence group(P<0.05, P<0.01).There were a statistically significant difference in the severity of cerebral infarction and intracranial vascular stenosis between the two groups(P<0.05, P<0.01). The MTT and TTP were positively correlated with the NIHSS score(r=0.671, r=0.704, P<0.05), while the CBV and CBF were negatively correlated with the NIHSS score(r=-0.546, r=-0.667, P<0.05). Multivariate logistic regression analysis indicated that NIHSS score, MTT, TTP, CBV, CBF, and severity of intracranial large vessel stenosis were independent influencing factors for stroke recurrence events(P<0.05, P<0.01). ROC curve analysis showed that the AUC values of MTT, TTP, CBV, and CBF were significantly lower than that of their combined detection, and the AUC values of multimodal CT imaging parameters and NIHSS score were notably lower than that of theire combined detection(P<0.01). Conclusion The parameters of multimodal CT imaging are closely associated with neurological function in elderly AIS patients. Combined detection of multimodal CT imaging parameters and NIHSS score has a high predictive value for stroke recurrence events.
[1]Pattath P, Odom EC, Tong X, et al. A comparison of acute ischemic stroke patients discharged to inpatient rehabilitation vs a skilled nursing facility:the paul coverdell national acute stroke program[J].Arch Phys Med Rehabil, 2023, 104(4):605-611. DOI:10.1016/j.apmr.2022.11.008.
[2]Zhang S, Zhang Y, Liu H, et al. Enriched environment remodels the central immune environment and improves the prognosis of acute ischemic stroke in elderly mice with chronic ischemia[J]. Front Immunol, 2023, 14:1114596. DOI:10.3389/fimmu.2023.1114596.
[3]Jiang X, Wang J, Hu Y, et al. Is endovascular treatment still good for acute ischemic stroke in the elderly? A meta-analysis of observational studies in the last decade[J]. Front Neurosci, 2024,17:1308216. DOI:10.3389/fnins.2023.1308216.
[4]Santo BA, Janbeh Sarayi SMM, McCall AD,et al. Multimodal CT imaging of ischemic stroke thrombi identifies scale-invariant radiomic features that reflect clot biology[J]. J Neurointerv Surg, 2023,15(12):1257-1263. DOI:10.1136/jnis-2022-019967.
[5]中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.轻型卒中临床诊疗中国专家共识（2024版）[J].中华神经科杂志，2025,58(5):462-474. DOI:10.3760/cma.j.cn113694-20250124-00057.
[6]Pensato U, Stebner A, Bosshart S, et al. Combining computed tomography perfusion and baseline National Institutes of Health Stroke Scale to assess the clinical penumbra in ischemic stroke[J]. J Stroke,2025, 27(2):270-274. DOI:10.5853/jos.2024.03720.
[7]Marto JP, Qureshi M, Nagel S, et al. Endovascular therapy for patients with low NIHSS scores and large vessel occlusion in the 6-to24-hour window:analysis of the CLEAR study[J]. Neurology, 2025,104(7):e213442. DOI:10.1212/WNL.0000000000213442.
[8]赵晨阳，李进，李东野，等.颅内动脉与颈动脉并存斑块分布特征对缺血性卒中复发风险的预测价值研究[J].中国卒中杂志，2024,19(6):647-654. DOI:10.3969/j.issn.1673-5765.2024.06.006.
[9]Grassl N, Baumann S, Kruska M, et al. Acute ischemic stroke and elevated troponin:Diagnostic work-up and therapeutic consequences[J].Dtsch Med Wochenschr, 2021, 146(8):534-541. DOI:10.1055/a-1308-7490.
[10]Hoelter P, Lang S, Beuscher V, et al. Extended multimodal flat detector CT imaging in acute ischemic stroke:a pilot study[J]. J Digit Imaging, 2023, 36(3):1198-1207. DOI:10.1007/s10278-022-00699-4.
[11]Jia RR, Meng XY, Lv HR, et al. Comparative time efficiency of CT and MRI multimodal imaging protocols in acute ischemic stroke evaluation[J]. J Craniofac Surg, 2025, 36(6):2007-2011. DOI:10.1097/SCS.0000000000011225.
[12]Li J, Luo Y, Liu P, et al. Development of a diagnostic prediction model for post-Stroke cognitive impairment in acute large vessel occlusion stroke using multimodal MRI and PET/CT:a study protocol[J].Brain Behav, 2025, 15(6):e70613. DOI:10.1002/brb3.70613.
[13]Furlanis G, Ricci E, Aj??evi c M, et al. Effectiveness of CT perfusion in posterior circulation stroke:evaluation of perfusion abnormalities and associated clinical signs[J]. J Neurol, 2025,272(3):225. DOI:10.1007/s00415-025-12933-4.
[14]Lei W, Zhuang H, Huang W, et al. Neuroinflammation and energy metabolism:a dual perspective on ischemic stroke[J]. J Transl Med,2025, 23(1):413. DOI:10.1186/s12967-025-06440-3.
[15]Ding L, Liu H, Jing J, et al. Lesion network mapping for neurological deficit in acute ischemic stroke[J]. Ann Neurol, 2023, 94(3):572-584. DOI:10.1002/ana.26721.
[16]Wang A, Jia B, Zhang X, et al. Efficacy and safety of butylphthalide in patients with acute ischemic stroke:a randomized clinical trial[J].JAMA Neurol, 2023, 80(8):851-859. DOI:10.1001/jamaneurol.2023.1871.
[17]Jud S, Kl??vekorn R, van Niftrik CHB, et al. High posterior cerebral artery flow predicts ischemia recurrence in patients with internal carotid artery occlusion[J]. Front Neurol, 2023,14:1193640. DOI:10.3389/fneur.2023.1193640.
[18]Chang CH, Ku CM, Ger TR, et al. Fractal-based quantitative collateral assessment for thrombectomy candidate selection in acute ischemic stroke:a preliminary study[J]. Diagnostics(Basel), 2025,15(13):1590. DOI:10.3390/diagnostics15131590.
基本信息:
中图分类号:R743.3
引用信息:
[1]章桃,李玉欣,钟正,等.多模态CT成像与老年急性缺血性脑卒中患者神经功能的关系及其对脑卒中复发事件的预测效能[J].中华老年心脑血管病杂志,2026,28(02):143-147.
基金信息:
湖南省卫生健康委科研计划项目（D202309016665）; 湖南省科技创新计划项目（2021SK53105）; 长沙市卫生健康委科研计划项目（KJ-A2023006）
2026-02-12
2026-02-12