脑白质高信号与缺血性卒中患者康复期独立生活预后的相关性研究  

Correlation of white matter hyperintensities with rehabilitation outcomes of independent activities of daily living in convalescent patients after ischemic stroke

作　　者：张尧[1] 尹俊雄[1] 

机构地区：[1]南京医科大学附属脑科医院神经内科,南京医学硕士210029

出　　处：《医学研究生学报》2016年第11期1148-1152,共5页Journal of Medical Postgraduates

摘　　要：目的功能独立性测量(functional independence measure,FIM)评分主要评估缺血性卒中疗养康复期患者日常生活活动独立程度,脑白质高信号(white matter hyperintensities,WMH)对疗养康复期的影响研究甚少。文中旨在分析不同部位及不同程度WMH对疗养康复期卒中患者的日常活动独立程度的影响。方法回顾性分析2015年1月到2015年10月南京医科大学附属脑科医院神经内科治疗的缺血性卒中康复期271例患者的临床资料,依据急性卒中治疗Org10172试验(TOAST)分型将患者分为:大动脉粥样硬化性卒中、心源性脑栓塞、小血管闭塞性卒中等。根据患者运动功能评分和认知功能评分进行FIM评分,按照修订后的Fazekas标准对患者MRI检查结果进行脑室旁白质高信号(periventricular hyperintensity,PVH)和深部脑白质高信号(deep white matter hyperintensity,DWMH)严重程度的评估,并采用多元线性回归分析确定患者恢复期日常活动功能恢复与WMH的关系。结果按照TOAST分型分类,大动脉粥样硬化性卒中患者120例,心源性脑栓塞患者67例,小血管闭塞患者39例,其他原因卒中患者20例,不明原因卒中25例。患者PVH和DWMH分级为1(1,2)和2(1,2),入院FIM评分为(79.1±9.4)分,出院FIM评分为(91.8±9.0)分。多元线性回归分析结果显示,卒中患者入院FIM评分(β=0.570,P<0.001)与患者出院FIM评分呈正相关,年龄(β=-0.212,P=0.001)和PVH分级(β=-0.126,P=0.020)与患者出院FIM评分呈负相关。按照TOSAT分型分层分析显示,大动脉粥样硬化性卒中患者入院FIM评分(β=0.250,P=0.002)、年龄(β=-0.305,P=0.018)和PVH分级(β=-0.350,P=0.003)与出院FIM评分相关;亦与心源性栓塞患者出院FIM评分相关。小血管闭塞性患者入院FIM评分(β=0.748,P<0.001)和PVH分级(β=-0.36,P=0.03)与出院FIM评分相关。所有患者及TOAST分层后的患者多元线性回归分析结果显示,患者DWMH分级与出院FIM评分均未见相关性(P>0.05)。结论�Objective The Functional Independence Measure( FIM) is widely used for assessing the degree of independent activities of daily living( ADL) in post-stroke patients. The effects of white matter hyperintensities( WMH) on the rehabilitation outcomes of post-stroke convalescent patients are little studied. We investigated the influence of WMH in different parts on the independence of ADL activities of convalescent patients after ischemic stroke.Methods We retrospectively analyzed the clinical data about 271 convalescent patients after ischemic stroke,who were classified into subtypes according to the TOAST classification system: large-artery atherosclerosis,cardioembolism,small-vessel occlusion,etc. We ob-tained the motor and cognitive FIM scores and WMH grades of the patients based on the modified Fazekas criteria for periventricular hyperintensity( PVH) and deep WMH( DWMH) and explored the relationship of WMH with the functional restoration of ADL by multivariate linear regression analysis. Results Of the 271 ischemic stroke patients,there were 120 with large-artery atherosclerosis,67 with cardioembolism,39 with small-vessel occlusion,20 with other causes,and 25 with unexplainable causes. The median degrees of PVH and DWMH were 1( 1-2) and 2( 1-2) and the mean FIM scores were 79.1±9.4 on admission and 91.8±9.0 at discharge,respectively. The FIM score at discharge was correlated positively with that on admission( β =-0.570,P<0.001) and negatively with the age( β =-0.212,P = 0.001) and PVH grade( β =-0.126,P = 0.020) of the patients. The FIM score on admission( β =-0.250,P =0.002),age( β =-0.305,P = 0.018) and PVH grade( β =-0.350,P = 0.003) were associated with the FIM scores at discharge in patients with large-artery atherosclerosis and those with cardioembolism. In those with small-vessel occlusion,the FIM score on admission( β = 0.748,P<0.001) and PVH grade( β =-0.360,P = 0.03) were associated with the FIM scores at discharge. No correlation was found between the DWMH grade and the FIM score at discharg

关 键 词：功能独立性测量 脑室旁白质高信号 深部脑白质高信号 TOAST病因分型 

分 类 号：R743.31[医药卫生—神经病学与精神病学]