Zhongguo cuzhong zazhi (Feb 2024)
18氟代脱氧葡萄糖PET/CT对活动性恶性肿瘤患者发生急性缺血性卒中预测作用研究 The Predictive Value of 18F-FDG PET/CT on Acute Ischemic Stroke in Patients with Active Cancer
Abstract
目的 探讨18氟代脱氧葡萄糖（18F-fluorodeoxyglucose，18F-FDG）PET/CT预测活动性恶性肿瘤（active cancer，AC）患者发生急性缺血性卒中（acute ischemic stroke，AIS）的标志物指标。 方法 回顾性纳入2021年1月—2022年5月于潍坊医学院第一附属医院行18F-FDG PET/CT检查的AC住院患者，根据其检查后1年内是否发生AIS分为AIS组和非AIS组，通过患者基本特征（性别、年龄、体重、恶性肿瘤部位、PET/CT检查前空腹血糖）进行1∶1倾向评分匹配，分析两组患者的临床及18F-FDG PET/CT影像学资料差异。影像学资料主要有颈动脉（carotid artery，CA）、升主动脉和主动脉弓（ascending aorta and aortic arch，AAO-AOA）、降主动脉（descending aorta，DAO）、髂动脉和股动脉（iliac artery and femoral artery，IA-FA）、内脏脂肪组织（visceral adipose tissue，VAT）、皮下脂肪组织（subcutaneous adipose tissue，SAT）以及全肠道（total bowel，TB）的靶本底比（target to background ratio，TBR），VAT和SAT面积以及两者比值。对单因素logistic回归中P＜0.1的变量采用逐步向后logistic回归筛选AC患者发生AIS的独立危险因素，应用ROC曲线评估独立危险因素联合模型对AIS的预测价值。 结果 共纳入88例患者，平均年龄（69.8±8.8）岁，男性占72.7%（64例），AIS组和非AIS组各 44例。AIS组合并冠心病比例较非AIS组高，CA、AAO-AOA、DAO、IA-FA、VAT、SAT以及TB的TBR均较非AIS组增高，而VAT面积较AIS组低，差异均有统计学意义。多因素logistic回归显示，冠心病（OR 3.92，95%CI 1.11～13.87，P=0.034）、CA TBR≥1.80（OR 2.90，95%CI 1.04～8.10，P=0.042）、DAO TBR≥2.30（OR 4.13，95%CI 1.45～11.75，P=0.008）、TB TBR≥3.34（OR 2.87，95%CI 1.01～8.12，P=0.047）和VAT TBR≥0.44（OR 3.92，95%CI 1.39～11.09，P=0.010）是AC患者发生AIS的独立危险因素，联合上述5个指标绘制ROC的AUC为0.821（95%CI 0.736～0.906，P＜0.001），预测肿瘤患者发生AIS的敏感度为68.2%，特异度为81.8%。 结论 有冠心病史，CA、DAO、VAT和TB的TBR增高是AC患者发生AIS的独立危险因素，上述5个指标联合对AC患者AIS的发生具有一定的预测价值。 Abstract: Objective To explore which indicators of 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging can be used as markers for predicting acute ischemic stroke (AIS) in active cancer (AC) patients. Methods Inpatients with AC who underwent 18F-FDG PET/CT in the First Affiliated Hospital of Weifang Medical University from January 2021 to May 2022 were retrospectively included, and divided into AIS group and non-AIS group according to whether they developed AIS within 1 year after the examination. According to the basic characteristics of the patients (gender, age, weight, cancer site, fasting blood glucose before PET/CT examination) by 1∶1 propensity score matching, clinical and 18F-FDG PET/CT imaging data of both groups of patients were analyzed, mainly including the target to background ratios (TBRs) of carotid arteries (CA), ascending aorta and aortic arch (AAO-AOA), descending aorta (DAO), iliac artery and femoral artery (IA-FA), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT) and total bowel (TB), the area of VAT and SAT and the ratio between the two. For variables with P<0.1 in univariate logistic regression, stepwise backward logistic regression was used to analyze the independent risk factors for AIS in AC patients. ROC curve was used to evaluate the predictive value of combined independent risk factors for AIS. Results A total of 88 patients were included (44 in the AIS group and 44 in the non-AIS group), with a mean age of (69.8±8.8) years and 72.7% (64 cases) of males. The proportion of coronary heart disease in AIS group was higher than that in non-AIS group, the TBRs of CA, AAO-AOA, DAO, IA-FA, VAT, SAT and TB were increased compared with non-AIS group, while the VAT area was lower than that in AIS group, and the differences were statistically significant. Multivariate logistic regression showed that coronary heart disease (OR 3.92, 95%CI 1.11-13.87, P=0.034), CA TBR≥1.80 (OR 2.90, 95%CI 1.04-8.10, P=0.042), DAO TBR≥2.30 (OR 4.13, 95%CI 1.45-11.75, P=0.008), TB TBR≥3.34 (OR 2.87, 95%CI 1.01-8.12, P=0.047) and VAT TBR≥0.44 (OR 3.92, 95%CI 1.39-11.09, P=0.010) were independent risk factors for AIS in AC patients. The AUC of ROC curve combined with these five indexes was 0.821 (95%CI 0.736-0.906, P<0.001), and the sensitivity and specificity of AIS prediction in tumor patients were 68.2% and 81.8%. Conclusions Coronary heart disease and the increased TBR of CA, DAO, VAT and TB are independent risk factors for AIS in AC patients, and the combination of these 5 indicators has certain predictive value for AIS in AC patients.
Keywords
