急性缺血性脑卒中患者缺血半暗带内的净水摄取量可预测中线移位的存在。
Net water uptake within the ischemic penumbra predicts the presence of the midline shift in patients with acute ischemic stroke.
作者信息
Chen Cuiping, Yang Jianhong, Han Qing, Wu Yuefei, Li Jichuan, Xu Tianqi, Sun Jie, Gao Xiang, Huang Yi, Parsons Mark W, Lin Longting
机构信息
Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
出版信息
Front Neurol. 2023 Sep 29;14:1246775. doi: 10.3389/fneur.2023.1246775. eCollection 2023.
OBJECTIVE
The study aimed to explore the association between midline shift (MLS) and net water uptake (NWU) within the ischemic penumbra in acute ischemic stroke patients.
METHODS
This was a retrospective cohort study that examined patients with anterior circulation stroke. Net water uptake within the acute ischemic core and penumbra was calculated using data from admission multimodal CT scans. The primary outcome was severe cerebral edema measured by the presence of MLS on 24 to 48 h follow-up CT scans. The presence of a significant MLS was defined by a deviation of the septum pellucidum from the midline on follow-up CT scans of at least 3 mm or greater due to the mass effect of ischemic edema. The net water uptake was compared between patients with and without MLS, followed by logistic regression analyses and receiver operating characteristics (ROCs) to assess the predictive power of net water uptake in MLS.
RESULTS
A total of 133 patients were analyzed: 50 patients (37.6%) with MLS and 83 patients (62.4%) without. Compared to patients without MLS, patients with MLS had higher net water uptake within the core [6.8 (3.2-10.4) vs. 4.9 (2.2-8.1), = 0.048] and higher net water uptake within the ischemic penumbra [2.9 (1.8-4.3) vs. 0.2 (-2.5-2.7), 0.001]. Penumbral net water uptake had higher predictive performance than net water uptake of the core in MLS [area under the curve: 0.708 vs. 0.603, < 0.001]. Moreover, the penumbral net water uptake predicted MLS in the multivariate regression model, adjusting for age, sex, admission National Institutes of Health Stroke Scale (NIHSS), diabetes mellitus, atrial fibrillation, ischemic core volume, and poor collateral vessel status (OR = 1.165; 95% CI = 1.002-1.356; = 0.047). No significant prediction was found for the net water uptake of the core in the multivariate regression model.
CONCLUSION
Net water uptake measured acutely within the ischemic penumbra could predict severe cerebral edema at 24-48 h.
目的
本研究旨在探讨急性缺血性脑卒中患者缺血半暗带内中线移位（MLS）与净吸水量（NWU）之间的关联。
方法
这是一项回顾性队列研究，纳入前循环卒中患者。利用入院时多模态CT扫描数据计算急性缺血核心区和半暗带内的净吸水量。主要结局是通过24至48小时随访CT扫描上是否存在MLS来衡量的严重脑水肿。显著MLS的存在定义为在随访CT扫描中，由于缺血性水肿的占位效应，透明隔与中线的偏差至少为3毫米或更大。比较有和没有MLS的患者的净吸水量，然后进行逻辑回归分析和受试者工作特征（ROC）分析，以评估净吸水量对MLS的预测能力。
结果
共分析了133例患者：50例（37.6%）有MLS，83例（62.4%）无MLS。与无MLS的患者相比，有MLS的患者核心区内净吸水量更高[6.8（3.2 - 10.4）对4.9（2.2 - 8.1），P = 0.048]，缺血半暗带内净吸水量也更高[2.9（1.8 - 4.3）对0.2（ - 2.5 - 2.7），P < 0.001]。在MLS方面，半暗带净吸水量比核心区净吸水量具有更高的预测性能[曲线下面积：0.708对0.603，P < 0.001]。此外，在多变量回归模型中，调整年龄、性别、入院时美国国立卫生研究院卒中量表（NIHSS）、糖尿病、心房颤动、缺血核心体积和侧支血管状况差等因素后，半暗带净吸水量可预测MLS（OR = 1.165；95%CI = 1.002 - 1.356；P = 0.047）。在多变量回归模型中未发现核心区净吸水量有显著预测作用。
结论
急性测量的缺血半暗带内净吸水量可预测24 - 48小时的严重脑水肿。
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