关键词: 急性脑梗死, 早期神经功能恶化, 弥散加权成像－阿尔伯塔卒中项目早期CT评分, 泛免疫炎症指数, D-二聚体/纤维蛋白原比值

Abstract: Objective To explore the predictive value of diffusion-weighted imaging - Alberta Stroke Program Early CT Score(DWI-ASPECTS),pan-immune inflammation index(PIV),and D-dimer(D-D)/fibrinogen(FIB) ratio(DFR) for early neurological deterioration(END) in elderly patients with acute cerebral infarction. Methods 217 elderly patients with acute cerebral infarction admitted from April 2024 to August 2025 were selected as the subjects.According to the increase in NIHSS score within 72 hours of onset compared with admission,those with an increase of ≥2 points in NIHSS score were included in the END group(37 cases),and those with an increase of less than 2 points in NIHSS score were included in the non-END group(180 cases).The clinical data of the two groups of patients were analyzed.The differences in DWI-ASPECTS,PIV and DFR levels between the END group and the non-END group were compared.Pearson correlation analysis was used to analyze the correlations between DWI-ASPECTS,PIV,DFR and END.The predictive value of DWI-ASPECTS,PIV and DFR for END in elderly patients with acute cerebral infarction was analyzed by using the area under the ROC curve. Results The levels of PIV and DFR in the END group were significantly higher than those in the non-END group,and the DWI-ASPECTS score was significantly lower than that in the non-END group.Elevated PIV(OR=1.032,P＜0.001) and DFR(OR=1.013,P＜0.001) are risk factors for END in elderly patients with acute cerebral infarction,while elevated DWI-ASPECTS score(OR=0.009,P＜0.001) is a protective factor for END in elderly patients with acute cerebral infarction.The increase of DWI-ASPECTS score was negatively correlated with the occurrence of END in elderly patients with acute cerebral infarction,while the increase of PIV and DFR levels was positively correlated with the occurrence of END in elderly patients with acute cerebral infarction.The Area Under the ROC Curve(AUC) of DWI-ASPECTS score,PIV,DFR and combined detection for predicting END in elderly patients with acute cerebral infarction was 0.807,0.775,0.774 and 0.911,respectively.Compared with the individual detection of each index,The AUC value of the combined detection of the three was the highest(Z=2.593,3.424,2.783,P＜0.001). Conclusion The DWI-ASPECTS score is relatively low in elderly patients with acute cerebral infarction and END,while the levels of PIV and DFR are relatively high in elderly patients with acute cerebral infarction and END.Detecting the levels of DWI-ASPECTS,PIV and DFR is helpful for clinically predicting the risk of END in elderly patients with acute cerebral infarction.

Key words: Acute cerebral infarction in the elderly, Early deterioration of neurological function, Diffusion-weighted imaging-alberta stroke program early CT score, Pan-immune inflammation value, D-dimer to fibrinogen ratio