摘要
目的探讨脑白质高信号(white matter hypertensities,WMHs)以及脑小血管病(cerebral small vessel disease,CSVD)总体负担与急性缺血性卒中患者临床转归的相关性。方法前瞻性纳入2018年11月至2019年6月在南京医科大学附属江宁医院神经内科住院治疗的急性缺血性卒中患者,记录人口统计学和临床资料。应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评估基线卒中严重程度,根据头颅MRI图像评估CSVD总体负担,根据Fazekas分级量表评估WMHs严重程度。采用改良Rankin量表评估发病后90 d时的功能转归,0~1分定义为转归良好,≥2分定义为转归不良。采用多变量logistic回归分析确定转归不良的独立危险因素。结果研究期间共纳入急性缺血性卒中患者153例,其中126例(82.35%)转归良好,27例(17.65%)转归不良。两组之间年龄、基线NIHSS评分、脂蛋白相关磷脂酶A2、Fazekas总分、脑室周围WMHs评分以及深部WMHs评分差异有统计学意义,而CSVD总体负担差异无统计学意义。多变量logistic回归分析显示,基线NIHSS评分(优势比1.245,95%可信区间1.023~1.515;P=0.028)及Fazekas总分(优势比1.635,95%可信区间1.049~2.549;P=0.030)是急性缺血性卒中患者发病后90 d时转归不良的独立危险因素。结论CSVD总体负担与急性缺血性卒中患者短期转归无关,WMHs和基线NIHSS评分是急性缺血性卒中患者短期转归不良的独立危险因素。
Objective To investigate the correlation between white matter hypertensities(WMHs)and the overall burden of cerebral small vessel disease(CSVD)and clinical outcome of patients with acute ischemic stroke.Methods From November 2018 to June 2019,patients with acute ischemic stroke hospitalized in the Department of Neurology,the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled prospectively.Their demographic and clinical data were collected.The National Institutes of Health Stroke Scale(NIHSS)was used to evaluate the baseline severity of stroke.The total burden of CSVD was evaluated according to the head MRI findings.The severity of WMHs was assessed based on Fazekas scale.The modified Rankin Scale(mRS)was used to evaluate the outcomes at 90 d after onset.The mRS score 0-1 was defined as good outcome,and≥2 was defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for poor outcomes.Results A total of 153 consecutive patients with acute ischemic stroke were enrolled,of which 126(82.35%)had a good outcome and 27(17.65%)had a poor outcome.There were significant differences in age,baseline NIHSS score,lipoprotein-associated phospholipase A2,total Fazekas score,periventricular WMHs score,and deep WMHs score between the two groups,while there was no significant difference in the total burden of CSVD.Multivariate logistic regression analysis revealed that the baseline NIHSS score(odds ratio 1.245,95%confidence interval 1.023-1.515;P=0.028)and the total Fazekas score(odds ratio 1.635,95%confidence interval 1.049-2.549;P=0.030)were the independent risk factors for poor outcomes at 90 d after the onset in patients acute ischemic stroke.Conclusions The overall burden of CSVD is not associated with the short-term outcomes in patients with acute ischemic stroke.WMHs and baseline NIHSS score are the independent risk factors for poor short-term outcomes in patients with acute ischemic stroke.
作者
王琳
赵小媛
江俊莹
张蕊
陈雪梅
余艳华
Wang Lin;Zhao Xiaoyuan;Jiang Junying;Zhang Rui;Chen Xuemei;Yu Yanhua(Department of Neurology,the Affiliated Jiangning Hospital of Nanjing Medical University,Nanjing 211100,China)
出处
《国际脑血管病杂志》
2020年第6期420-425,共6页
International Journal of Cerebrovascular Diseases
基金
南京市卫生和青年人才培养项目(QRX17032)
南京医科大学科技发展项目(NMUB2019240)
南京医科大学康达学院科研发展项目(KD2019KYJJYB047)。
关键词
卒中
脑缺血
脑小血管疾病
白质
磁共振成像
治疗结果
Stroke
Brain ischemia
Cerebral small vessel diseases
White matter
Magnetic resonance imaging
Treatment outcome
作者简介
通信作者:陈雪梅,Email:13347808579@189.cn;通信作者:余艳华,Email:fyj721208@sina.com。
