Clinical Study On The Relationship Between CT Perfusion Imaging Combined With Serum C-Reactive Protein And Acute Cerebral Vasospasm After Spontaneous Subarachnoid Hemorrhage

Background Subarachnoid hemorrhage(SAH)is the main cerebrovascular disease of death and disability in human beings,and the fatality rate within 30 days is about 25%or higher.About 30% of those who survive still have moderate to severe neurological impairment.Clinical cerebral vasospasm(CVS)is a common high risk complication after SAH,the cerebral ischemia and cerebral infarction caused by it is the important cause of death,disability.Current studies have shown that late-onset CVS is related to poor prognosis of patients,but timely treatment of CVS in the acute phase is a significant factor affecting clinical prognosis.Early detection of CVS and proactive measures are essential to alleviate CVS,reduce the incidence of CVS-related complications and late-onset CVS,and improve prognosis.At present,the main methods to diagnose CVS include DSA and TCD,both of which have certain limitations.CT perfusion imaging(CTP)not only clearly reflects cerebral ischemia caused by large or central vasospasm,but also can more sensitively detect the vasospasm occurring in microcirculation,so as to have the advantages of rapid,simple and so on,but with low specificity.Some scholars preliminarily demonstrated its value and function in the diagnosis of cerebral ischemia lesions,not only sensitive to the lesions;This makes up for the fact that traditional methods cannot understand the ischemic state histologically.At present in view of the occurrence and development of CVS mechanism related studies show that inflammation plays an important role in the CVS,as the representative inflammation indicators a index,serum high sensitivity C-reactive protein in the inflammatory response,is a clinical routine testing project,low cost,and early warning to the diagnosis of subarachnoid hemorrhage after the CVS has a certain value,In addition,previous studies have shown that the heavier CVS is in the acute phase,the higher the incidence of complications,and the worse the prognosis may be.CTP combined with serum C-reactive protein detection is expected to improve the diagnosis rate of CVS in the acute stage and provide guidance for the treatment of CVS.Objective To investigate the relationship between cerebral CT perfusion imaging and serum C-reactive protein and the clinical prognosis of CVS in the acute phase after subarachnoid hemorrhage,and then to explore the correlation between CTP and serum C-reactive protein and CVS after subarachnoid hemorrhage,so as to provide the basis for diagnosis and treatment of CVS.Methods According to the inclusion and exclusion criteria,patients with spontaneous subarachnoid hemorrhage diagnosed in the Sixth Affiliated Hospital of Guangzhou Medical University from January 2019 to January 2020 were selected to complete DSA examination and TCD examination 3d-7d after admission.Assess vasospasm.CT perfusion examination was performed within 3d to assess the level of cerebral ischemia after SAH.According to TCD and DSA results,patients were divided into CVS group and non-CVS group.The hunt-Hess score,Fisher score,WFNS score and MRS score,c-reactive protein level at the first,third and seventh days after admission,CT perfusion result,cerebral blood flow(CBF),cerebral blood volume(CBV),and mean transit time of contrast media were recorded.MTT)and time to Peak(TTP).To analyze the relationship between CTP combined with C-reactive protein and CVS and its prognosis.Results The CTP parameters of CVS group and non-CVS group were changed to different degrees.The CBF and CBV of CVS patients were lower than that of non-CVS patients,and the MTT and TTP were longer than that of non-CVS patients,with statistically significant differences(P <0.05).The serum C-reactive protein level of the CVS group was higher than that of the non-CVS group on the 3rd and 7th day after onset,and the difference was statistically significant(P <0.05).C-reactive protein level was correlated with prognosis on the third day.,and the difference was statistically significant(P <0.05).Hunt-hess score was correlated with cerebral vascular perfusion(P <0.05).Conclusions 1.CT perfusion imaging showed that low perfusion,Hunt-Hess score and Fisher score could predict cerebral vasospasm.2.In patients with subarachnoid hemorrhage,CRP at day 3rd and 7th was associated with the onset of CVS at the acute stage,and CRP at day 3 was associated with the prognosis of the patients.3.CT perfusion imaging combined with serum C-reactive protein level can diagnose cerebral vasospasm.4.Early CVS after subarachnoid hemorrhage is associated with patient prognosis.