CTPI评价亚急性期脑出血后周围组织的血流动力学变化

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摘要目的：应用320排容积CT灌注成像（CTPI）研究亚急性期高血压性脑出血（HICH）后周围组织的血流动力学变化。方法：对21例HICH患者于发病后4～14 d行CTPI检查，测量脑血肿体积、脑血肿周围（边缘区、外层区）及对侧镜像区的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及达峰时间（TTP），
并计算相对灌注参数值rCBF、rCBV、rMTT及rTTP（患侧/健侧）。采用成组t检验对边缘区、外层区及其相应镜像区域各参数值、边缘区、外层区相对灌注参数值进行分析；采用Pearson相关性分析血肿体积、发病时间与血肿周围（边缘区及外层区）rCBF、rCBV、rMTT及rTTP的相关性。结果：亚急性期脑血肿边缘区CBF、CBV均较对侧镜像区降低，差异有统计学意义（tCBF=-4.442，PCBF＜0.01；tCBV=-4.139，PCBV＜0.01），TTP较镜像区显著延长，差异有统计学意义（tTTP=4.030，PTTP＜0.01），MTT较镜像区有所缩短，差异无统计学意义（tMTT=-1.631，PMTT＞0.05）。血肿外层区CBF较镜像区减低，差异有统计学意义（tCBF=-2.196，PCBF＜0.05），MTT较镜像区延长，差异有统计学意义（tMTT=2.093，PMTT＜0.05），CBV及TTP与镜像区对比，差异无统计学意义（tCBV＝-0.776，PCBV＞0.05；tTTP＝0.336，PTTP＞0.05）。血肿边缘区rCBF、rCBV均较外层区减低，差异有统计学意义（trCBF＝-2.688，PrCBF＜0.05；trCBV＝-3.124，PrCBV＜0.01）；rMTT较外层区缩短，差异有统计学意义（trMTT＝-2.770，PrMTT＜0.05）；而rTTP较外层区延长，差异有统计学意义（trTTP＝3.574，PrTTP＜0.01）。血肿体积与血肿周围rCBF、rCBV、rMTT及血肿外层区rTTP均无显著相关性，与血肿边缘区rTTP有相关性（r=0.472，P＜0.05）。发病时间与血肿周围（边缘区和外层区）rCBF、rCBV、rMTT及血肿边缘区rTTP无显著相关性，与血肿外层区rTTP有相关性（r=0.441，P＜0.05）。结论：亚急性期HICH血肿周围存在脑灌注减低，且血肿周围rCBF、rCBV与血肿体积、发病时间无明显相关。

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关键词 ：脑出血；亚急性期；体层摄影术, X线计算机；灌注

Abstract：Objective: To study the perihematomal hemodynamics changes in patients with subacute hypertensive intracerebral hemorrhage using 320-row volume CT perfusion imaging. Methods: CTPI was performed in twenty-one patients from 4 days to 14 days after the onset of HICH. The volume of the hematomas was measured, and the perfusion parameter values of the marginal zone and outer zone of the intracerebral hematoma and contralateral mirror were measured, including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time-to-peak (TTP), and rCBF, rCBV, rMTT and rTTP were calculated by ipsilateral/contralateral value. The differences of perfusion parameter values between the marginal zone or the outer zone and the mirror area, and the differences of relative perfusion parameters values between marginal and outer zone were analyzed by paired samples t test. Relationships between the volume of hematomas and the time from the onset to the CTPI performance and rCBF, rCBV, rMTT and rTTP of marginal and outer area were analyzed by Pearson correlation analysis. Results: ①Compared with the mirror area, the CBF and CBV of the marginal zone showed lower perfusion and there was significant statistical difference (tCBF=-4.442, PCBF<0.01; tCBF=-4.139, PCBV<0.01), the TTP was more delayed in the marginal zone, and there was significant statistical difference (tTTP=4.030, PTTP<0.01), and the MTT of marginal zone was shorter but there was no significant statistical difference (tMTT=-1.631, PMTT>0.05); The CBF of the outer zone presented lower perfusion than the mirror area and there was significant statistical difference (tCBF=-2.196, PCBF<0.05), MTT was longer than that of the mirror area, there was significant statistical difference (tMTT=-2.093, PMTT<0.05), and there was no statistically difference between the CBV or TTP of outer and mirror area (tCBV=-0.776, PCBV>0.05 and tTTP=0.336, PTTP>0.05). The rCBF and rCBV in the marginal zone were lower than those in the outer zone, and there was significant statistical difference (trCBF=-2.688, PrCBF<0.05 and trCBV=-3.124, PrCBV<0.01 respectively). rMTT was significantly shorter (trMTT=-2.770, PrMTT<0.05) than it in the outer zone, but rTTP was more delayed in the marginal zone (trTTP=3.574, PrTTP<0.01). ②There was no significant relationship between the volume of subacute hematomas and rCBF, rCBV, rMTT of the marginal zone and the outer zone or rTTP of the outer zone, and there was significant relationship between that and rTTP of the marginal zone. There was also no significant relationship between the time from onset to the CTPI performance and rCBF, rCBV, rMTT of the marginal zone or the outer zone and rTTP of the marginal zone, and there was significant relationship between that and rTTP of the outer zone (r=0.441, P<0.05). Conclusion: Hypoperfusion still remained in perihematomal region of subacute hypertensive intracerebral hematoma, furthermore there is no significant correlation between rCBF and rCBV of perihematoma and the volume of hematoma and the time from onset to CPTI performance.

Key words： intracerebral hemorrhage subacute tomography, X-ray computed perfusion

收稿日期: 2015-01-26

基金资助:浙江省公益性技术应用研究项目（2011C23021）；温州市科技局公益性研究项目（Y20140733）。

通讯作者: 陈伟建，主任医师，Email：wyyycwj@163.com。

作者简介: 周洁洁（1984-），女，浙江温州人，住院医师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I10 /753

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