| Objective:To study the permeability of blood brain barrier(BBB)in acute ischemic stroke(AIS)patients according to the quantitative assessment by dynamic contrast-enhanced(DCE)MRI,and to analyze its influencing factors.Methods:1.Prospective method was used in this study.A total of 79 patients with AIS admitted to North Jiangsu People’s Hospital from October 2017 to May 2019 were collected,and relevant clinical data of these patients were recorded,including gender,age,blood pressure,NIHSS score,cerebral infarction volume,cardiogenic embolism,carotid atherosclerosis,and previous disease history(hypertension,diabetes,atrial fibrillation and cerebral infarction)and laboratory indicators(fasting blood glucose,glycated hemoglobin,blood lipids,fibrinogen and homocysteine),etc.2.The patients were divided into 3 groups according tothe treatments they accepted,including 19 cases in the conventional treatment group,27 in the intravenous thrombolysis group,and 33 in the thrombectomy group.They were given brain DWI,DCE-MRI and CT scan within 72h after symptom onset(at baseline).CT scans were given to evaluate the presence of hemorrhagic transformation(HT)on day 7 from the symptom onset.13 cases underwent DCE-MRI again on day 14 after symptom onset.The patients were followed up for 3 months,during which their mRS score was recorded.The out come of the patients with a mRS score of 0-2 was assessed as good.3.The T1 DCE-MRI extend model was used to calculate the BBB permeability index,that is,volume transport constant Ktrans value.The ratios of the Ktrans value on the infarct side to the contralateral side(Ki/c)were calculated.SPSS 23.0 software was used for statistical analysis.The difference of Ktrans value and Ki/c value between the infarct side and the contralateral side on the day 14 after symptom onset and the baseline was compared.The difference of lg(Ki/c)value in 3 groups was compared.The relationship between BBB permeability and prognosis was analyzed.Its relationship to HT was analyzed,too.The factors related with lg(Ki/c)value were analyzed by multivariate linear regression analysis.Results:1.The Ktrans values in the infarct sides of all patients were significantly higher than those of the contralateral sides[0.0044(0.0019,0.0084)/min vs 0.0009(0.0003,0.0017)/min,P=0.000].Among them,The Ktrans values in the infarct sides of the conventional drug group[0.0034(0.0017,0.0097)/min vs 0.0011(0.0003,0.0025)/min,P=0.001],the intravenous thrombolytic group[0.0044(0.0016,0.0084)/min vs 0.0009(0.0003,0.0014)/min,P=0.000]and the thrombectomy group[0.0056(0.0024,0.0083)/min vs 0.0005(0.0002,0.0021)/min,P=0.000]were significantly higher than those of the contralateral sides.2.The Ki/c values on day 14 were significantly higher than those at baseline[41.71(13.88,97.15)vs 6.26(3.76,18.15),P=0.001].3.Univariate analysis of variance showed that there was a significant difference in lg(Ki/c)value among the three groups(P=0.022).The lg(Ki/c)value of the conventional treatment group was 0.51±0.45,the lg(Ki/c)value of the intravenous thrombolysis group was 0.78±0.36,and the lg(Ki/c)value of the thrombectomy group was 0.84±0.43.The lg(Ki/c)values in the intravenous thrombolysis group and the thrombectomy group(P=0.034,P=0.007)were significantly higher than those in the conventional treatment group.However,there was no significant difference when the Ig(Ki/c)value of the intravenous thrombolysis group and the thrombectomy group were compared(P=0.563).4.According to the logistic regression analysis,cerebral infarction volume were related to prognosis(P=0.009).5.According to the logistic regression analysis,both cerebral infarction volume(P=0.005)and the Ki/c values were related to HT(P=0.006).6.According to the multivariate linear regression analysis,both treatment plan(P=0.006)and history of cerebral infarction were related to the lg(Ki/c)values(P=0.041).Conclusion:1.After acute ischemic stroke,the permeability of BBB of the infarct side was higher than those of the contralateral side.2.The permeability of BBB of acute ischemic stroke on day 14 from symptom onset was significantly higher than that within 72 hours.3.Compared with conventional medicine therapy,thrombolysis and thrombectomy increased the permeability of BBB.The permeability of BBB in the early stage of stroke did not significantly correlate to the clinical prognosis of the patients 3 months after symptom onset,4.On day 7 from symptom onset,the BBB permeability of patients with HT was significantly higher than that of patients without HT.5.The permeability of BBB may be related to different treatment methods and previous history of cerebral infarction in AIS patients. |
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