SOMATOM Force双源CT颅脑灌注联合sdLDL-C、MOTS-c在急性脑梗死中的诊断价值

Diagnostic value of dual source force CT brain perfusion combined with sdLDL-C and MOTS-c in patients with acute cerebral infarction

摘要:

目的 研究SOMATOM Force双源CT颅脑灌注联合小而密低密度脂蛋白胆固醇（sdLDL-C）、线粒体衍生肽（MOTS-c）在急性脑梗死（ACI）中的诊断价值。方法 选取广州医科大学第三附属医院2019年5月—2020年8月治疗的疑似ACI患者102例。所有患者接受SOMATOM Force双源CT检查及颅脑灌注成像。采用逐步多因素Logistic回归分析影响ACI的因素；采用Pearson法分析MOTS-c、sdLDL-C与脑血容量（CBV）、脑血流量（CBF）、达峰时间（TTP）、平均通过时间（MTT）的相关性；采用受试者工作特征（ROC）曲线分析sdLDL-C、MOTS-c、SOMATOM Force双源CT颅脑灌注诊断ACI的临床价值。结果 102例患者经脑部CT及磁共振成像检查确诊ACI 78例（ACI组），无ACI 24例（无ACI组）。ACI组患者的CBV、CBF、MOTS-c低于无ACI组，MTT、TTP、sdLDL-C高于无ACI组（P <0.05）。Pearson相关分析显示，MOTS-c与CBV（r =0.435，P =0.000）、CBF（r =0.457，P =0.000）呈正相关，与MTT（r =-0.523，P =0.000）、TTP（r =-0.422，P =0.000）呈负相关，sdLDL-C与CBV（r =-0.427，P =0.000）、CBF（r =-0.443，P =0.000）呈负相关，与MTT（r =0.486，P =0.000）、TTP（r =0.414，P =0.000）呈正相关。逐步多因素Logistic回归分析显示：CBV［O^R=0.352（95% CI：0.145，0.858）］、CBF［O^R=0.397（95% CI：0.194，0.816）］、MOTS-c［O^R=0.456（95% CI：0.255，0.815）］为ACI的保护因素（P <0.05），MTT［O^R=2.022（95% CI：1.392，3.075）］、TTP［O^R=1.931（95% CI：1.085，3.436）］及sdLDL-C［O^R=2.416（95% CI：1.085，5.513）］为ACI的危险因素（P <0.05）。MOTS-c、sdLDL-C、SOMATOM Force双源CT颅脑灌注及联合诊断的敏感性分别为71.8%、83.3%、79.5%和85.9%，特异性分别为83.3%、83.3%、70.8%和87.5%。MOTS-c、sdLDL-C、SOMATOM Force双源CT颅脑灌注诊断ACI曲线下面积为0.818（95% CI：0.705，0.932）、0.788（95% CI：0.670，0.907）、0.804（95% CI：0.712，0.896），均低于联合诊断的0.877（95% CI：0.779，0.973）（P <0.05）。结论 sdLDL-C、MOTS-c在ACI患者中异常表达，与SOMATOM Force双源CT颅脑灌注参数有相关性，联合检测ACI有较高的诊断价值。

Abstract:

Objective To study the diagnostic value of dual source force CT brain perfusion combined with sdLDL-C and mitochondrial open reading frame of the 12S rRNA-c (MOTS-c) in patients with acute cerebral infarction.Methods From May 2019 to August 2020, 102 patients with suspected acute cerebral infarction admitted to The Third Affiliated Hospital of Guangzhou Medical University were selected. All subjects underwent dual source force CT examination and brain perfusion imaging. Logistic regression analysis was used to analyze the influencing factors of acute cerebral infarction. Receiver operating characteristic curve (ROC curve) was used to analyze the clinical value of sdLDL-C and MOTS-c and dual source force CT in the diagnosis of acute cerebral infarction.Results Among 102 patients, 78 had acute cerebral infarction and 24 had no acute cerebral infarction. The levels of serum MOTS-c, CBV, and CBF in the cerebral infarction group were lower than non-cerebral infarction group, while sdLDL-C, MTT, and TTP were higher than those in the non-cerebral infarction group (P < 0.05). Pearson correlation analysis showed that mots-c were positively correlated with CBV (r = 0.435, P = 0.000) and CBF (r = 0.457, P = 0.000), and negatively correlated with MTT (r = -0.523, P = 0.000) and TTP (r = -0.422, P = 0.000). SdLDL-c were negatively correlated with CBV (r = -0.427, P = 0.000) and CBF (r = -0.443, P = 0.000), and positively correlated with MTT (r = 0.486, P = 0.000) and TTP (r = 0.414, P = 0.000). Logistic regression analysis showed that CBV level [O^R = 0.352 (95% CI: 0.145, 0.858) ], CBF level [O^R = 0.397 (95% CI: 0.194, 0.816) ], and MOTS-c level [O^R = 0.456 (95% CI: 0.255, 0.815) ] were the protective factor for acute cerebral infarction (P < 0.05); MTT level [O^R = 2.022 (95% CI: 1.392, 3.075) ], TTP level [O^R = 1.931 (95% CI: 1.085, 3.436) ], and sdLDL- C level [O^R = 2.416 (95% CI: 1.085, 5.513) ] were the risk factor for acute cerebral infarction (P < 0.05). The sensitivities of MOTS-c, sdLDL-C, CT cranial perfusion, and combined detection in the diagnosis of acute cerebral infarction were 71.8%, 83.3%, 79.5%, and 85.9%, respectively, and the specificities were 83.3%, 83.3%, 70.8%, and 87.5%, respectively. The area under the curve for diagnosis of acute cerebral infarction by MOTS-c, sdLDL-C, and CT brain perfusion were 0.818 (95% CI: 0.705, 0.932), 0.788 (95% CI: 0.670, 0.907), and 0.804 (95% CI: 0.712, 0.896), which were significantly lower than the combined diagnosis 0.877 (95% CI: 0.779, 0.973) (P < 0.05).Conclusion SdLDL-C and MOTS-c are abnormally expressed in patients with acute cerebral infarction, and there is a correlation with dual-source force CT craniocerebral perfusion parameters. Combined detection can improve the diagnostic value of patients with acute cerebral infarction.