Correlation between Total Cerebral Small Vessel Diseases Burden and Long-term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolysis

doi:10.3969/j.issn.1673-5765.2020.06.015

Abstract

Abstract:

Objective To explore the relationship between the total cerebral small vessel diseases (CSVD) burden and 1-year outcome after intravenous thrombolysis in patients with acute ischemic stroke. Methods This prospective study consecutively enrolled patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) and underwent MRI between January 2017 and December 2018. The total burden score of CSVD was calculated according to MRI results. 1-year outcome after stroke was evaluated using the modified Rankin scale (mRS). Multivariate logistic regression analysis was used to identify the relationship between the total burden score of CSVD and 1-year poor prognosis. ROC curve analysis was used to determine the area under the curve (AUC) and optimal cut-off value of the total CSVD score for predicting 1-year poor outcome. Results A total of 135 patients were included, with an average age of 61.56±12.64 years old. There were 17 cases (12.59%) with a total CSVD score of 0, 44 cases (32.59%) with a score of 1, 38 cases (28.15%) with a score of 2, 30 cases (22.22%) with a score of 3, and 6 cases (4.44%) with a score of 4. Multivariate analysis showed that NIHSS at admission (OR 1.615, 95%CI 1.209-2.157, P =0.001) and total CSVD score (OR 1.570, 95%CI 1.095-4.094, P =0.026) were independent risk factors for 1-year outcome. The AUC and optimal cut-off value of total CVSD score and NIHSS score at admission for predicting 1-year poor outcome were 0.735 (95%CI 0.641-0.828) and 2.5, 0.773 (95%CI 0.684-0.862) and 6.5, respectively. Conclusions The total CSVD burden score and NIHSS score at admission were independent influencing factors for 1-year outcome after intravenous thrombolysis in acute ischemic stroke.

Key words: Cerebral small vessel disease; Total burden score; Ischemic stroke; Intravenous thrombolysis; Long-term prognosis

摘要：

目的探讨脑小血管病（cerebral small vessel disease，CSVD）总负荷评分与急性缺血性卒中（acute ischemic stroke，AIS）患者静脉溶栓后1年预后的关系。方法前瞻性连续纳入2017年1月-2018年12月于深圳市人民医院神经内科住院并接受rt-PA静脉溶栓治疗的AIS患者，根据MRI评估CSVD负荷并计算CSVD总负荷评分。使用mRS量表评估患者发病1年的神经功能预后，利用多因素Logistic回归分析确定CSVD的总负荷与1年的神经功能预后之间的关系，利用ROC曲线分析CSVD总负荷评分对不良预后的预测价值及最佳界值。结果最终入组135例静脉溶栓的AIS患者，平均年龄为61.56±12.64岁，CVSD总负荷评分0分者17例（12.59%），1分者44例（32.59%），2分者38例（28.15%），3分者30例（22.22%），4分者6例（4.44%）。多因素分析发现溶栓前NIHSS评分（OR 1.615，95%CI 1.209～2.157，P =0.001）、CSVD总负荷评分（OR 1.570，95%CI 1.095～4.094，P =0.026）为AIS静脉溶栓患者1年功能预后的独立影响因素。CSVD总负荷预测静脉溶栓后1年不良预后的ROC曲线下面积（area under the ROC curve，AUC）为0.735（95%CI 0.641～0.828），最佳界值为2.5分；溶栓前NIHSS评分的AUC为0.773（95%CI 0.684～0.862），最佳界值为6.5分。结论 CSVD总负荷评分及溶栓前NIHSS评分为AIS患者静脉溶栓治疗1年功能预后不良的可靠预测指标，有助于临床评估静脉溶栓患者长期预后。

关键词: 脑小血管病; 总负荷评分; 缺血性卒中; 静脉溶栓; 长期预后

YANG Miao-Juan, ZENG Si-Lin, XU Qian-Hui, FANG Jun-Lin,WANG Ying, GUO Yi. Correlation between Total Cerebral Small Vessel Diseases Burden and Long-term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolysis[J]. Chinese Journal of Stroke, 2020, 15(06): 655-661.

杨苗娟，曾思琳，徐铅辉，方俊林，王颖，郭毅. 脑小血管病总负荷评分与静脉溶栓治疗急性缺血性卒中患者1年预后相关性研究[J]. 中国卒中杂志, 2020, 15(06): 655-661.

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