中国卒中杂志 ›› 2009, Vol. 4 ›› Issue (08): 634-639.

• 论著 • 上一篇    下一篇

脑小血管病对卒中后转归和并发症的影响

林琅,张微微,赵秀欣,黄勇华,郭文华   

  1. 100700 北京市北京军区总医院神经内科(第一作者系第三军医大学博士研究生)
  • 收稿日期:2009-03-17 修回日期:2009-03-17 出版日期:2009-08-20 发布日期:2009-08-20
  • 通讯作者: 林琅

Effect of Small Vessel Diseases on the Outcome and Complications of Acute Cerebral Infarct Patients

LIN Lang, ZHANG Wei-Wei, ZHAO Xiu-Xin, et al.   

  1. Department of Neurology, Beijing Military General Hospital, Beijing 100700, China
  • Received:2009-03-17 Revised:2009-03-17 Online:2009-08-20 Published:2009-08-20
  • Contact: LIN Lang

摘要:

【摘要】 目的 探讨脑小血管病对急性缺血性卒中患者临床转归和相关并发症的影响。 方法 对2007年1月至2008年1月的323名的急性缺血性卒中连续病例进行了前瞻性研究。磁共振检查被用于判定白质疏松和脑小腔隙灶严重程度,并对发病后3个月内的并发症发生情况及卒中转归情况进行了评估。Logistic逐步回归分析用于评估卒中后不良转归和并发症的独立预测因素。 结果 在观察期内,128名患者(39.63%)转归不良(死亡或残疾),69名患者(21.36%)发生了肺炎。白质疏松是不良转归和肺炎的独立预测因素[不良转归:比值比(Odds ratio,OR)3.971,95%可信区间(Confidence interval,CI)1.954~8.073;肺炎:OR 1.809,95%CI 1.220~2.681],但脑小腔隙灶和卒中后不良转归及相关并发症没有发现有显著联系。 结论 白质疏松是急性缺血性卒中患者不良转归和肺炎发生的独立预测因素,尽管白质疏松和脑小腔隙灶都是脑小血管病的主要影像学表现,但脑小腔隙灶没有发现和急性卒中患者预后具有显著性关联。白质疏松和脑小腔隙灶对卒中预后的不同影响提示了两者的异质性。

关键词: 【关键词】 脑白质疏松症; 脑小腔隙灶; 脑梗死; 预后; 并发症

Abstract:

Abstract】 Objective To determine the effect of small vessel diseases on the clinical outcome and relative complications of acute ischemic stroke patients. Methods Between January 2007 and January 2008, 323 consecutive patients with acute brain infarction were studied prospectively. Leukoaraiosis was defined as moderate or severe white matter hyperintensities and lacunes were counted into none (0 lacune), few (1-2 lacunes), and many (3 or more lacunes). The stroke outcome and incidence of complications during a period of three months after the onset of stroke were assessed. Backward stepwise logistic regression was used to identify the independent predictors of adverse outcome and complications after stroke. Results During the fellow-up, 128 patients (39.63%) had adverse outcomes (death or disability) and 69 patients (21.36%) developed pneumonia. Leukoaraiosis was an independent predictor of adverse outcome and pneumonia (for adverse outcome: OR 3.971, 95%CI 1.954-8.073; for pneumonia: OR 1.809, 95%CI 1.220-2.681) while no association between lacunes and adverse outcome or any complications after stroke was found. Conclusion Leukoaraiosis but not lacunes was independent predictor of adverse outcome and pneumonia for acute ischemic stroke patients. The difference between the effects of lacunes and leukoaraiosis may reflect the heterogeneity of such two main aspects of small vessel diseases.

Key words: 【Key Words】 Leukoaraiosis; Lacunes; Brain infarction; Prognosis; Complication