CT灌注成像联合血清microRNA-493预测急性脑梗死患者预后的价值

Prognostic value of CT perfusion imaging combined with the serum level of microRNA-493 in patients with acute cerebral infarction

摘要:

目的 分析CT灌注成像联合血清microRNA-493（miR-493）预测急性脑梗死（ACI）患者预后的价值。方法 选取2019年6月—2022年11月湖北文理学院附属医院收治的149例ACI患者，所有患者治疗前行CT灌注成像及血清miR-493测定，溶栓治疗后均随访3个月，评估其预后情况。分析影响ACI患者预后的因素，分析CT灌注成像参数联合血清miR-493预测ACI患者预后的价值。结果 149例ACI患者中20例预后不良。多因素逐步Logistic回归分析结果显示，美国国立卫生研究院卒中量表评分［O^R=5.743（95% CI：2.363，13.958）］、脑血流量（CBF）［O^R=3.931（95% CI：1.618，9.555）］、脑血容量（CBV）［O^R=3.827（95% CI：1.575，9.301）］、灌注对比剂平均通过时间（MTT）［O^R=3.615（95% CI：1.487，8.785）］、miR-493 ［O^R=3.873（95% CI：1.594，9.412）］是影响ACI患者预后的因素（P <0.05）。受试者工作特征曲线结果分析结果显示，CBF、CBV、MTT、miR-493及四者联合预测ACI患者预后的敏感性分别为70.00%（95% CI：0.457，0.872）、75.00%（95% CI：0.506，0.904）、70.00%（95% CI：0.457，0.872）、65.00%（95% CI：0.410，0.837）、85.00%（95% CI：0.641，0.960），特异性分别为70.54%（95% CI：0.618，0.781）、79.85%（95% CI：0.717，0.862）、73.64%（95% CI：0.650，0.808）、71.32%（95% CI：0.626，0.788）、89.92%（95% CI：0.831，0.943），AUC分别为0.734、0.798、0.733、0.739和0.906。结论 CT灌注成像参数CBF、CBV、MTT联合血清miR-493预测ACI患者预后效能良好。

Abstract:

Objective To analyze the prognostic value of CT perfusion imaging combined with the serum level of microRNA-493 (miR-493) in patients with acute cerebral infarction (ACI).Methods A total of 149 ACI patients admitted to our hospital from June 2019 to November 2022 were selected. All patients underwent CT perfusion imaging and detection of the serum level of miR-493 before treatment, and were followed up for 3 months after thrombolytic therapy to evaluate their prognosis. Factors influencing the prognosis of ACI patients were analyzed, and the value of CT perfusion imaging parameters combined with the serum level of miR-493 in predicting the prognosis of ACI patients was determined.Results Among 149 patients with ACI, 20 had a poor prognosis. Multivariable Logistic regression analysis showed that the National Institutes of Health Stroke Scale (NIHSS) score [O^R = 5.743 (95% CI: 2.363, 13.958) ], cerebral blood flow (CBF) [O^R = 3.931 (95% CI: 1.618, 9.555) ], cerebral blood volume (CBV) [O^R = 3.827 (95% CI: 1.575, 9.301) ], mean transit time (MTT) [O^R = 3.615 (95% CI: 1.487, 8.785) ] and the level of miR-493 [O^R = 3.873 (95% CI: 1.594, 9.412) ] were factors affecting the prognosis of ACI patients (P < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the sensitivities of CBF, CBV, MTT, miR-493 and their combination for predicting the prognosis of ACI patients were 70.00% (95% CI: 0.457, 0.872), 75.00% (95% CI: 0.506, 0.904), 70.00% (95% CI: 0.457, 0.872), 65.00% (95% CI: 0.410, 0.837), and 85.00% (95% CI: 0.641, 0.960), with the specificities being 70.54% (95% CI: 0.618, 0.781), 79.85% (95% CI: 0.717, 0.862), 73.64% (95% CI: 0.650, 0.808), 71.32% (95% CI: 0.626, 0.788), and 89.92% (95% CI: 0.831, 0.943), and the areas under the curves (AUCs) being 0.734, 0.798, 0.733, 0.739, and 0.906.Conclusions CT perfusion imaging parameters CBF, CBV and MTT combined with the serum level of miR-493 are effective in predicting the prognosis of ACI patients.