中风与神经疾病杂志2026，Vol.43Issue(1)：15-19,5.DOI:10.19845/j.cnki.zfysjjbzz.2026.0003
脑小血管病总负荷评分联合3D-ASL技术在急性缺血性脑卒中患者静脉溶栓中的应用价值
Application value of total cerebral small vessel disease score combined with three-dimensional arterial spin labeling in predicting the prognosis of patients with acute ischemic stroke after intravenous thrombolysis
摘要
Abstract
Objective To investigate the value of total cerebral small vessel disease(CSVD)score combined with three-dimensional arterial spin labeling(3D-ASL)in predicting the prognosis of patients with acute ischemic stroke(AIS)after 90 days of intravenous thrombolysis.Methods A total of 189 AIS patients who were consecutively admitted to Department of Neurology,Changshu Hospital Affiliated to Nantong University,from January 2021 to June 2023 and underwent intravenous thrombolysis with al-teplase were enrolled,and multimodal brain MRI was performed to assess total CSVD load and cerebral blood flow in the area of re-sponsibility.A multivariate logistic regression analysis was used to identify the independent influencing factors for poor 90-day progno-sis in AIS patients undergoing intravenous thrombolysis.The receiver operating characteristic(ROC)curve was used to investigate the value of total CSVD score and 3D-ASL used alone or in combination in predicting the prognosis of AIS.Results The multivariate regression analysis showed that diabetes(OR=3.601,95%CI 1.448-8.954,P=0.006),total CSVD score≥3 points(OR=4.077,95%CI 1.785-9.313,P=0.001),and baseline NIHSS score(for every 1-point increase:OR=1.167,95%CI 1.061-1.283,P=0.001)were independent risk factors for poor prognosis in AIS patients on day 90 after intravenous thrombolysis,while ASL hyperper-fusion was an independent protective factor against poor prognosis(OR=0.16,95%CI 0.050-0.356,P=0.014).The ROC curve analysis showed that the predictive model based on CSVD score and ASL perfusion had a C-value of 0.844(95%CI 0.786-0.902,P<0.05)and thus had the best predictive efficacy.Conclusion Total CSVD score combined with 3D-ASL can more comprehen-sively reflect the whole brain circulation network and has a better effect than each indicator alone in predicting the 90-day prognosis of AIS patients undergoing intravenous thrombolysis.关键词
急性缺血性脑卒中/脑小血管病总负荷评分/三维动脉自旋标记磁共振灌注技术/静脉溶栓/联合诊断Key words
Acute ischemic stroke/Total cerebral small vessel disease score/Three-dimensional arterial spin labeling/Intravenous thrombolysis/Combined diagnosis分类
医药卫生引用本文复制引用
卓子良,卓颖,谭佳宁,刘晖,赵宗波,仲伟,严满云,顾洋..脑小血管病总负荷评分联合3D-ASL技术在急性缺血性脑卒中患者静脉溶栓中的应用价值[J].中风与神经疾病杂志,2026,43(1):15-19,5.基金项目
苏州科技发展计划面上项目(SYW2024049) （SYW2024049）
常熟市卫健委重点项目(CSWS202506) （CSWS202506）
常熟市卫健委昆承人才项目(KCH202402) （KCH202402）
