Abstract: Objective  To explore the correlation between lacunes of presumed vascular origin and health status in patients with acute ischemic stroke after onset, and to dynamically observe their effects on the recovery speed of health status, thereby providing a reference for the accurate assessment of health status after acute ischemic stroke.
Methods  Acute ischemic stroke patients hospitalized at the Sixth People’s Hospital of Nanhai District from July 2021 to July 2024 were prospectively and consecutively included. The lacunes of presumed vascular origin and other imaging indicators were recorded according to the results of brain MRI. At the same time, baseline data such as age, previous medical history, admission NIHSS score, and laboratory test results were also recorded. The patients’ health status was evaluated at 90 and 180 days after onset via telephone or outpatient follow-up using the European five-dimension five-level questionnaire (EQ-5D-5L), which evaluates five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Univariate and multivariate logistic regression analyses were used to analyze the correlation between lacunes of presumed vascular origin (and other baseline indicators) and poor health status (defined as an EQ-5D-5L score≤0.5) at 90 days after onset. The recovery speed of health status at 180 days after onset was dynamically observed. Univariate and multivariate logistic regression analyses were also used to determine the correlation between lacunes of presumed vascular origin (and other baseline indicators) and slow recovery of health status (defined as the 180-day EQ‑5D‑5L score minus the 90-day EQ‑5D‑5L score≤0). Subgroup analysis was conducted to compare the incidence of poor health status at 90 days and the recovery speed of health status at 180 days among patients with mild versus severe lacunes of presumed vascular origin.
Results  A total of 682 acute ischemic stroke patients were enrolled, including 354 patients with lacunes of presumed vascular origin and 328 patients without. Among the patients, 376 had good health status at 90 days after onset, and 306 had poor health status. Multivariate logistic regression analysis showed that lacunes of presumed vascular origin were independent risk factors for poor health status at 90 days after onset (OR 1.632, 95%CI 1.107-2.406, P=0.013). Compared to the status at 90 days after onset, 241 patients (35.3%) showed slow recovery at 180 days after onset, including 144 patients with and 97 patients without lacunes of presumed vascular origin. Multivariate logistic regression analysis showed that lacunes of presumed vascular origin were independent risk factors for slow recovery of health status in patients with acute ischemic stroke (OR 1.324, 95%CI 1.035-1.696, P=0.026). Subgroup analysis revealed that at 90 days, the incidence of poor health status was higher in the severe lacunes of presumed vascular origin group than in the mild group (78.2% vs. 36.7%, P＜0.001). At 180 days, the proportion of patients with slow recovery of health status was also higher in the severe group than in the mild group (51.0% vs. 33.3%, P=0.001).
Conclusions  Lacunes of presumed vascular origin are independent risk factors for poor health status and slow recovery in patients with acute ischemic stroke after onset. The more severe the lacunes of presumed vascular origin, the higher the incidence of poor health status after stroke, and the slower the recovery of their health status.

Key words: Lacune of presumed vascular origin; Acute ischemic stroke; Health status

摘要： 目的 探索血管源性腔隙灶与急性缺血性卒中患者发病后生命健康状况的相关性，并动态观察其对生命健康状况恢复速度的影响，为急性缺血性卒中后生命健康状况的准确评估提供依据和参考。
方法 前瞻性连续纳入2021年7月—2024年7月于佛山市南海区第六人民医院住院的急性缺血性卒中患者。根据入院后头颅MRI检查结果记录患者血管源性腔隙灶及其他影像学指标情况，同时记录其年龄、既往病史、入院NIHSS评分、实验室检查结果等信息。分别在发病90 d及180 d通过电话及门诊随访等方式，采用欧洲五维五级健康问卷（European five-dimension five-level questionnaire，EQ-5D-5L）从多维度（包括移动能力、自我照顾、日常活动、疼痛或不适、焦虑或抑郁等）评估患者的生命健康状况。通过单因素及多因素logistic回归分析明确血管源性腔隙灶及其他基线指标与患者发病90 d生命健康状况欠佳（EQ-5D-5L评分≤0.5分）的相关性。动态观察发病180 d时患者生命健康状况的恢复速度，通过单因素及多因素logistic回归分析明确血管源性腔隙灶及其他基线指标与患者生命健康状况恢复缓慢（180 d EQ-5D-5L评分-90 d EQ-5D-5L评分≤0分）的相关性。通过亚组分析，比较轻度与重度血管源性腔隙灶患者生命健康状况欠佳发生率及生命健康状况恢复速度的差异。
结果 共纳入682例急性缺血性卒中患者，其中血管源性腔隙灶患者354例，非血管源性腔隙灶患者328例；发病90 d生命健康状况良好患者376例，生命健康状况欠佳患者306例。多因素logistic回归分析表明，血管源性腔隙灶是急性缺血性卒中患者发病90 d生命健康状况欠佳的独立危险因素（OR 1.632，95%CI 1.107～2.406，P=0.013）。与发病90 d时相比，发病180 d时有241例（35.3%）患者生命健康状况恢复缓慢，其中血管源性腔隙灶患者144例，非血管源性腔隙灶患者97例。多因素logistic回归分析显示，血管源性腔隙灶是急性缺血性卒中患者生命健康状况恢复缓慢的独立危险因素（OR 1.324，95%CI 1.035～1.696，P=0.026）。亚组分析显示，发病90 d时血管源性腔隙灶重度组生命健康状况欠佳的发生率较轻度组高（78.2% vs. 36.7%，P＜0.001），发病180 d时血管源性腔隙灶重度组生命健康状况恢复缓慢的患者占比较轻度组高（51.0% vs. 33.3%，P=0.001）。
结论 血管源性腔隙灶是急性缺血性卒中患者发病后生命健康状况欠佳及恢复缓慢的独立危险因素。血管源性腔隙灶越严重，患者卒中后生命健康状况欠佳的发生率越高，恢复速度越慢。

关键词: 血管源性腔隙灶; 急性缺血性卒中; 生命健康状况