Zhongguo cuzhong zazhi (Sep 2022)

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 Association of White Matter Hyperintensities with Clinical Outcome in Patients with Isolated Middle Cerebral Artery Severe Stenosis or Occlusion

  • 豆朋宇，班梦苛，贵永堃，包万利，张平

DOI
https://doi.org/10.3969/j.issn.1673-5765.2022.09.012
Journal volume & issue
Vol. 17, no. 9
pp. 985 – 990

Abstract

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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，P2 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.

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