急性缺血性卒中患者脑小血管病总负荷与静脉溶栓治疗转归的关系研究

doi:10.3969/j.issn.1673-5765.2020.07.007

摘要/Abstract

摘要：

目的探讨急性缺血性卒中（acute ischemic stroke，AIS）患者脑小血管病（cerebral small vessel disease，CSVD）总体负荷与静脉溶栓治疗转归的关系。方法回顾性纳入2012年3月-2018年1月于同济大学附属同济医院神经内科接受静脉溶栓治疗的 AIS患者，根据头颅MRI评估CSVD总体负荷（CSVD总负荷评分），在发病后90 d时采用mRS量表评估患者预后，良好预后定义为mRS评分≤2分。使用多因素Logistic回归分析AIS静脉溶栓患者90 d预后不良（mRS评分≥3分）及住院期间并发症（住院期间新发的肺部感染、消化道出血和泌尿道感染）的独立影响因素。结果最终纳入178例患者，平均年龄62.3±10.5岁，其中男性125例（70.2%）。90 d预后良好患者共128例（71.9%）。多因素分析显示：糖尿病（OR 2.919，95%CI 1.044～8.162，P =0.041），吸烟（OR 7.752，95%CI 2.300～26.192，P =0.001），心房颤动（OR 6.553,95%CI 1.733～24.785，P =0.006），基线 NIHSS评分（每增加1分：OR 1.354，95%CI 1.224～1.497，P＜0.001），CSVD总负荷评分≥3分（OR 3.787， 95%CI 1.127～12.728，P =0.031）是AIS患者静脉溶栓90 d预后不良的独立危险因素。基线NIHSS评分（每增加1分：OR 1.266，95%CI 1.163～1.377，P＜0.001）及CSVD总负荷评分≥3分（OR 4.643，95%CI 1.562～13.801，P =0.006）是AIS静脉溶栓患者住院期间并发症的独立危险因素。结论 CSVD总负荷评分≥3分是静脉溶栓患者90 d不良预后的独立危险因素。

文章导读： 脑小血管病总负荷评分能全面地量化评估全脑小血管病变情况，对卒中单元静脉溶栓患者不良预后及住院期间并发症的预测具有一定价值。

关键词: 急性缺血性卒中; 脑小血管病总负荷评分; 静脉溶栓; 不良预后

Abstract:

Objective To investigate the relationship between the overall burden of cerebral small vessel disease (CSVD) and in-hospital outcomes after intravenous thrombolysis in acute ischemic stroke (AIS) patients. Methods AIS patients who underwent intravenous thrombolysis with rt-PA in Department of Neurology, Tongji Hospital from March, 2012 to January, 2018 were retrospectively analyzed. The total CSVD score was assessed based on brain MRI. 90-day prognosis was evaluated by using mRS, and good prognosis was defined as a mRS score of 0 to 2. Multivariate logistic regression was used to analyze the influencing factors associated with 90-day poor prognosis (mRS score≥3) and inhospital complications after intravenous thrombolysis in AIS patients. Results A total of 178 patients were included, with a mean age of 62.3±10.5 years and 125 males (70.2%). 128 patients (71.9%) had good prognosis at 90 days. Multivariate analysis showed that diabetes (OR 2.919, 95%CI 1.044-8.162, P =0.041), smoking (OR 7.752, 95%CI 2.300-26.192, P =0.001), atrial fibrillation (OR 6.553, 95%CI 1.733-24.785, P =0.006), NIHSS score at admission (OR 1.354, 95%CI 1.224-1.497, P <0.001) and total CSVD score ≥3 points (OR 3.787, 95%CI 1.127-12.728, P =0.031) were independent risk factors for poor prognosis in AIS patients treated with intravenous thrombolysis. NIHSS score at admission (OR 1.266, 95%CI 1.163-1.377, P <0.001) and total CSVD score ≥3 points (OR 4.643, 95%CI 1.562-13.801, P =0.006) were independent risk factors for in-hospital complications in AIS patients treated with intravenous thrombolysis. Conclusions The total CSVD score ≥3 points was independent risk factor for 90-day poor prognosis after intravenous thrombolysis in AIS patients.

Key words: Acute ischemic stroke; Total cerebral small vessel disease score; Intravenous thrombolysis; Poor prognosis

卓子良，聂志余，刘渊华，郑国将，毛相濡，刘梦，刘务朝. 急性缺血性卒中患者脑小血管病总负荷与静脉溶栓治疗转归的关系研究[J]. 中国卒中杂志, 2020, 15(07): 734-739.

ZHUO Zi-Liang, NIE Zhi-Yu, LIU Yuan-Hua, ZHEN Guo-Jiang,MAO Xiang-Ru, LIU Meng, LIU Wu-Chao. Correlation between Total Burden of Cerebral Small Vessel Disease and Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke Patients[J]. Chinese Journal of Stroke, 2020, 15(07): 734-739.

参考文献

[1] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国脑小血管病诊治共识[J]. 中华

神经科杂志，2015，48（10）：838-844.

[2] STAALS J，MAKIN S D，DOUBAL F N，et al.

Stroke subtype，vascular risk factors，and total MRI

brain small-vessel disease burden[J]. Neurology，

2014，83（14）：1228-1234.

[3] 中华医学会神经病学分会，中华医学会神经病学分

会脑血管病学组. 中国急性缺血性脑卒中诊治指南

2014[J]. 中华神经科杂志，2015，48（4）：246-257.

[4] 中国高血压防治指南修订委员会. 中国高血压防治

指南2010[J]. 中华心血管病杂志，2011，39（7）：579-

616.

[5] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南

（2013年版）[J]. 中国医学前沿杂志（电子版），2015，7

（3）：26-89.

[6] 中国成人血脂异常防治指南修订联合委员会. 中国

成人血脂异常防治指南（2016年修订版）[J]. 中华健

康管理学杂志，2017，11（1）：7-28.

[7] FAZEKAS F，CHAWLUK J B，ALAVI A，et al.

MR signal abnormalities at 1.5 T in Alzheimer’s

dementia and normal aging[J]. Am J Neuroradiol，

1987，8：421-426.

[8] DOUBAL F N，MACLULLICH A M J，FERGUSON

K J，et al. Enlarged perivascular spaces on MRI are

a feature of cerebral small vessel disease[J]. Stroke，

2010，41（3）：450-454.

[9] FARRELL C，CHAPPELL F，ARMITAGE P A，

et al. Development and initial testing of normal

reference MR images for the brain at ages 65-70 and

75-80 years[J]. Eur Radiol，2009，19（1）：177-183.

[10] HELENIUS J，HENNINGER N. Leukoaraiosis

burden significantly modulates the association

between infarct volume and National Institutes of

Health Stroke Scale in ischemic stroke[J]. Stroke，

2015，46（7）：1857-1863.

[11] DANNENBERG S，SCHEITZ J F，ROZANSKI

M，et al. Number of cerebral microbleeds and

risk of intracerebral hemorrhage after intravenous

thrombolysis[J]. Stroke，2014，45（10）：2900-2905.

[12] YAKUSHIJI Y，CHARIDIMOU A，HARA M，et

al. Topography and associations of perivascular

spaces in healthy adults：the Kashima scan study[J].

Neurology，2014，83（23）：2116-2123.

[13] LAU K K，LI L X，SCHULZ U，et al. Total small

vessel disease score and risk of recurrent stroke：

validation in 2 large cohorts[J]. Neurology，2017，88

（24）：2260-2267.

[14] ARBA F，INZITARI D，ALI M，et al. Small

vessel disease and clinical outcomes after IV rt-PA

treatment[J]. Acta Neurol Scand，2017，136（1）：72-

77.

[15] 朱慧，付文君，赵丽贤，等. 脑小血管病总体负担与大

动脉粥样硬化性卒中转归的相关性[J]. 国际脑血管

病杂志，2018，26（3）：167-171.

[16] STAALS J，BOOTH T，MORRIS Z，et al. Total

MRI load of cerebral small vessel disease and

cognitive ability in older people[J]. Neurobiol Aging，

2015，36（10）：2806-2811.

[17] FAZEKAS F，FRAYNE R，WARDLAW J M，et

al. Neuroimaging standards for research into small

vessel disease and its contribution to ageing and

neurodegeneration[J]. Lancet Neurol，2013，12（8）：

822-838.

[18] 邓毫斌，伍大华. 急性脑卒中相关性肺炎的危险因

素分析[J]. 卒中与神经疾病，2018，25（5）：583-585，

589.

[19] 林琅，张微微，赵秀欣，等. 脑小血管病对卒中后转

归和并发症的影响[J]. 中国卒中杂志，2009，4（8）：

634-639.