老年患者大脑中动脉恶性梗死的预测
Prediction of Malignant Middle Cerebral Artery Infarction in Elderly Patients.
作者信息
Goto Yuko, Kumura Eiji, Watabe Tadashi, Nakamura Hajime, Nishino Akio, Koyama Takashi, Taniwaki Koichi, Yuguchi Takamichi, Yoshimine Toshiki
机构信息
Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan.
出版信息
J Stroke Cerebrovasc Dis. 2016 Jun;25(6):1389-95. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.034. Epub 2016 Apr 20.
BACKGROUND
We evaluated the clinical outcomes of malignant middle cerebral artery (MCA) infarction (MMI) and determined an infarcted brain volume (BV) threshold value for accurate MMI prediction in elderly patients.
METHODS
We analyzed 69 consecutive patients (mean, 75.6 ± 11.7) with internal carotid artery or MCA infarction within 48 hours from onset. Diffusion-weighted high-intensity volume (DHV) and BV were measured in all patients. The percentage of DHV within BV (DHV/BV ratio) was calculated to standardize the DHV difference for each individual BV. Patients were stratified based upon their MMI status and age, compared with the following: (1) MMI versus non-MMI groups and (2) age ≥75 years group versus age <75 years group, based on DHV values, DHV/BV ratio, Glasgow Coma Scale (GCS) scores on admission, and modified Rankin Scale (mRS) scores at 3 months after onset.
RESULTS
The MMI group (n = 14) showed significantly larger DHV values (P < .001), larger DHV/BV ratios (P < .001), lower GCS scores on admission (P < .01), and higher mRS scores at 3 months (P < .001) than the non-MMI group. The DHV threshold value predicting MMI was 102 cm(3) (sensitivity 85%, specificity 91%, P < .01) and DHV/BV threshold ratio was 7.8% (sensitivity 86%, specificity 87%, P < .01). Both the age ≥75 years group and the age <75 years group with MMI showed equally poor outcomes (mRS 5.7 ± .7 versus 5.3 ± 1.3).
CONCLUSIONS
DHV and DHV/BV can provide reliable information for MMI prediction in elderly patients.
背景
我们评估了大脑中动脉恶性梗死（MMI）的临床结局，并确定了梗死脑体积（BV）阈值，以准确预测老年患者的MMI。
方法
我们分析了69例连续患者（平均年龄75.6±11.7岁），这些患者在发病后48小时内发生颈内动脉或大脑中动脉梗死。测量了所有患者的弥散加权高强度体积（DHV）和BV。计算BV内DHV的百分比（DHV/BV比值），以标准化每个个体BV的DHV差异。根据MMI状态和年龄对患者进行分层，并与以下情况进行比较：（1）MMI组与非MMI组；（2）年龄≥75岁组与年龄<75岁组，比较指标包括DHV值、DHV/BV比值、入院时格拉斯哥昏迷量表（GCS）评分以及发病后3个月的改良Rankin量表（mRS）评分。
结果
MMI组（n = 14）的DHV值显著更大（P <.001），DHV/BV比值更高（P <.001），入院时GCS评分更低（P <.01），发病后3个月mRS评分更高（P <.001）。预测MMI的DHV阈值为102 cm³（敏感性85%，特异性91%，P <.01），DHV/BV阈值比值为7.8%（敏感性86%，特异性87%，P <.01）。年龄≥75岁的MMI组和年龄<75岁的MMI组预后同样较差（mRS分别为5.7±0.7和5.3±1.3）。
结论
DHV和DHV/BV可为老年患者MMI的预测提供可靠信息。
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