脑白质高信号与孤立大脑中动脉重度狭窄或闭塞患者临床预后的相关性研究

doi:10.3969/j.issn.1673-5765.2022.09.012

摘要/Abstract

摘要： 目的探讨脑白质高信号（white matter hyperintensity，WMH）与孤立大脑中动脉（middle cerebral artery，MCA）重度狭窄或闭塞患者临床预后的关系。
方法前瞻性连续纳入就诊于新乡医学院第一附属医院神经内科，发病在72 h内的孤立MCA M1段重度狭窄或闭塞的急性缺血性卒中患者。收集患者的临床资料，入院时采用NIHSS评估卒中严重程度，采用Fazekas评估WMH严重程度。本研究的主要结局为发病90 d和1年时的神经功能结局，根据mRS将患者分为预后良好（mRS 0～2分）和预后不良（mRS>2分）组，单因素分析比较2组的基线指标、WMH等脑小血管病影像学指标、侧支循环评级等因素；采用多因素分析判断预后不良的独立危险因素。本研究的次要结局包括卒中进展、发病90 d和1年卒中复发，采用单因素logistic回归分析评估WMH与发病3 d内卒中进展、随访90 d和1年卒中复发的关系。
结果最终纳入117例患者，男性74例（63.2%），平均60.6±9.9岁。90 d随访时，60例患者预后良好，57例患者预后不良，多因素logistic回归分析显示Fazekas总分（OR 1.612，95%CI 1.245～2.087，P<0.001）、入院时NIHSS（OR 1.215，95%CI 1.025～1.440，P=0.025）、侧支循环不良（OR 3.111，95%CI 1.188～8.142，P=0.021）是预后不良的独立危险因素；1年随访时，86例患者预后良好，31例患者预后不良，多因素logistic回归分析显示Fazekas总分（OR 1.495，95%CI 1.083～2.065，P=0.014）、入院时NIHSS（OR 1.725，95%CI 1.359～2.193，P<0.001）、侧支循环不良（OR 4.217，95%CI 1.218～14.598，P=0.023）与预后不良独立相关。单因素logistic回归分析显示WMH与卒中进展及复发无相关性。
结论 WMH与MCA重度狭窄或闭塞患者临床预后密切相关，高Fazekas总分、入院时NIHSS评分高、侧支循环不良可作为评定MCA重度狭窄或闭塞患者临床预后的独立危险因素。

文章导读： 本研究前瞻性地选择孤立性MCA M1段重度狭窄或闭塞的急性缺血性卒中患者，进行了统一标准的头颅MRI检查及影像判断，发现评估WMH的Fazekas总分升高与患者90 d和1年预后不良有关，但与卒中复发无明确相关性。

关键词: 脑白质高信号; 大脑中动脉; 动脉狭窄; 闭塞; 临床预后

Abstract: Objective To explore the relationship between cerebral white matter hyperintensities (WMH) and clinical outcome in patients with isolated middle cerebral artery (MCA) severe stenosis or occlusion.
Methods This study prospectively enrolled the consecutive acute ischemic stroke patients with severe stenosis or occlusion of isolated MCA M1 segment who were admitted to the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical College within 72 hours of onset. Clinical data of the patients were collected. NIHSS score was used to assess the severity of stroke on admission, and Fazekas score was used to assess the severity of WMH. The primary outcomes were functional outcome (mRS score) at 90 days and 1 year, with a mRS score of 0-2 as good outcome and >2 as poor outcome. The secondary outcomes were stroke progression with 3 days of onset, stroke recurrence within 90 days and 1 year. Multivariate logistic regression analysis was used to identify independent risk factors for 90-day and 1-year clinical outcome.
Results A total of 117 patients were included, with an average age of 60.61±9.92 years and 74 males (63.2%). At 90-day follow-up, 60 patients had a good prognosis and 57 patients had a poor prognosis. Multivariate logistic regression analysis showed that the total Fazekas score (OR 1.612, 95%CI 1.245-2.087, P<0.001), baseline NIHSS (OR 1.215, 95%CI 1.025-1.440, P=0.025), poor collateral circulation (OR 3.111, 95%CI 1.188-8.142, P=0.021) were associated with 90-day poor prognosis. At 1-year follow-up, 86 patients had a good prognosis, 31 patients had a poor prognosis. Multivariate logistic regression analysis showed that the total Fazekas score (OR 1.495, 95%CI 1.083-2.065, P=0.014), baseline NIHSS (OR 1.725, 95%CI 1.359-2.193, P<0.001), poor collateral circulation (OR 4.217, 95%CI 1.218-14.598, P=0.023) were associated with 1-year poor prognosis. Univariate logistic regression analysis showed that WMH had no correlation with stroke progression and recurrence.
Conclusions WMH is closely related to clinical outcomes of patients with severe MCA stenosis and occlusion. Poor collateral circulation and high baseline NIHSS score were independent risk factors for clinical outcome of patients with severe MCA stenosis or occlusion.

Key words: White matter hyperintensity; Middle cerebral artery; Stenosis; Occlusion; Clinical prognosis

豆朋宇, 班梦苛, 贵永堃, 包万利, 张平. 脑白质高信号与孤立大脑中动脉重度狭窄或闭塞患者临床预后的相关性研究[J]. 中国卒中杂志, 2022, 17(09): 985-990.

DOU Pengyu, BAN Mengke, GUI Yongkun, BAO Wanli, ZHANG Ping. Association of White Matter Hyperintensities with Clinical Outcome in Patients with Isolated Middle Cerebral Artery Severe Stenosis or Occlusion[J]. Chinese Journal of Stroke, 2022, 17(09): 985-990.

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