【摘要】 目的 探究CT灌注成像(CTP)在不同剂量阿托伐他汀治疗症状性颅内动脉狭窄(s ICAS)临床疗效评估中的应用价值。方法 选取2021年12月至2023年8月平顶山市第一人民医院收治的s ICAS患者129例，依据阿托伐他汀治疗剂量将其分为低剂量组(10mg/d)、标准剂量组(20mg/d)以及强化组(40mg/d)，各43例，三组均接受阿托伐他汀治疗并持续3个月，评价三组的治疗效果及治疗前、后CTP参数[脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、残余功能达峰时间(TMax)]的差异。依据3个月后的治疗效果将129例患者分为症状改善组(显效+有效)与无改善(无效)组，比较两组患者CTP参数的差异性，绘制ROC曲线分析CTP相关参数预测阿托伐他汀治疗后s ICAS患者症状改善的价值。结果 三组的治疗有效率分别为69.77%(30/43)、72.09%(31/43)和93.02%(40/43)，强化组治疗有效率均较低剂量组与标准剂量组更高(P<0.05)。3个月后，强化组患者的CBF、CBV均高于剂量组与标准剂量组，其MTT、TMax均较低于剂量组与标准剂量组(P<0.05)。本研究纳入129例患者，经3个月治疗后症状改善101例，无改善28例，症状改善组患者其CBF、CBV均高于无改善组，MTT、TMax均低于无改善组(P<0.05)。CTP各参数联合预测托伐他汀治疗后s ICAS患者症状改善情况的AUC为0.917,95%CI为0.855～0.958，其预测效能均较CBF、CBV、MTT、TMax单一指标预测效能更高(Z=4.152、3.204、2.680、3.042,P<0.05)。结论 40mg/d阿托伐他治疗s ICAS效果显著，可显著改善患者脑血管的血流灌注情况，通过CTP检查能够有效评估阿托伐他汀治疗sICAS的临床效果，促进患者的预后。更多还原

【Abstract】 Objective To investigate the application value of CT perfusion imaging(CTP) in evaluating the clinical efficacy of different doses of atorvastatin in the treatment of symptomatic intracranial artery stenosis(sICAS). Methods A total of 129 sICAS patients admitted to the First People’s Hospital of Pingdingshan City from December 2021 to August 2023 were selected and divided into low-dose group(10mg/d), standard-dose group(20mg/d) and intensive group(40mg/d) according to the therapeutic dose of atorvastatin, with 43 cases in each group. All three groups received atorvastatin treatment for 3 months. The therapeutic effect and the differences of CTP parameters(cerebral blood flow(CBF), cerebral blood volume(CBV), mean time to transit(MTT), and time to peak in brain tissue(TMax)) before and after treatment among the three groups were evaluated. According to the treatment effect after 3 months, 129 patients were divided into symptom improvement group(significant + effective)and no improvement group(ineffective). The difference of CTP parameters between the two groups was compared, and ROC curve was drawn to analyze the value of CTP related parameters in predicting symptom improvement of sICAS patients after atorvastatin treatment. Results The effective rates of the three groups were 69.77%(30/43), 72.09%(31/43) and 93.02%(40/43). The effective rates of the intensive group were higher than those of the low dose group and the standard dose group(P<0.05). After 3 months, the CBF and CBV of the intensive group were higher than those of the dose and standard dose groups, and the MTT and TMax of the intensive group were lower than those of the dose and standard dose groups(P<0.05). In this study, 129 patients were included. After 3 months of treatment, 101 patients had improved symptoms and 28 patients had no improvement. The CBF and CBV of patients in symptom improvement group were higher than those in no improvement group, and MTT and TMax were lower than those in no improvement group(P<0.05). The combined prediction of CTP parameters for symptom improvement in sICAS patients after torvastatin treatment was 0.917 AUC and 95%CI was 0.855-0.958. The prediction efficiency was higher than that of CBF, CBV, MTT and TMax(Z=4.152, 3.204, 2.680, 3.042, P<0.05). Conclusion 40mg/d atorvastat is effective in the treatment of sICAS,which can significantly improve the cerebrovascular blood perfusion of patients. CTP examination can effectively evaluate the clinical effect of atorvastatin in the treatment of sICAS, and promote the prognosis of patients.更多还原