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  

Correlation between total burden of cerebral small vessel disease and outcomes in large artery athemsclemtic stroke

作　　者：朱慧 付文君 赵丽贤 赵仁亮[2] Zhu Hui;Fu Wenjun;Zhao Lixian;Zhao Renliang(Qingdao University Medical College, Qingdao 266021, China;Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China)

机构地区：[1]青岛大学医学院,266021 [2]青岛大学附属医院神经内科,266003

出　　处：《国际脑血管病杂志》2018年第3期167-171,共5页International Journal of Cerebrovascular Diseases

基　　金：山东省医药卫生科技发展计划项目（2014WS0455）

摘　　要：目的 探讨脑小血管病（cerebral small vessel disease,CSVD）总体负担与大动脉粥样硬化性（large artery atherosclerotic,LAA）卒中患者转归的关系.方法 回顾性纳入2016年6月至2018年1月期间在青岛大学附属医院神经内科住院治疗的LAA卒中患者,根据MRI检查结果评估CSVD总体负担,采用美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale,NIHSS）评估卒中严重程度,在发病后90 d时采用改良Rankin量表进行预后评估,0～2分定义为转归良好,＞2分定义为转归不良.结果 共纳入148例LAA卒中患者,转归良好72例（48.65％）,转归不良76例（51.35％）.2组高血压（69.44％对85.52％;x2=5.519,P=0.019）、发病前服用抗高血压药（48.61％对69.74％;x2=6.845,P=0.009）、脑白质高信号（18.06％对39.47％;x2=8.228,P=0.004）、血管周围间隙扩大（33.33％对60.53％;x2=10.968,P=0.001）的患者构成比以及基线NIHSS评分[3.0（2.0～ 4.0）分对7.0（5.0～ 10.0）分;Z=-8.159,P＜0.001]、基线收缩压[（149.40±15.80）mmHg对（157.21±14.05）mmHg;t 3.180,P=0.002;1 mmHg=0.133kPa]、空腹血糖[（5.91±2.06） mmol/L对（6.92±2.65） mmol/L;t=2.595,P=0.010]及CSVD总评分为0、1、2、3、4分的患者比例（Z=-4.927,P＜0.001）存在显著差异.校正高血压、空腹血糖等混杂因素后,多变量回归分析显示,CSVD总评分（优势比4.457,95％可信区间1.768～11.236;P=0.002）和基线NIHSS评分（优势比2.070,95％可信区间1.580 ～2.710;P＜0.001）是LAA型卒中患者转归不良的独立危险因素.结论 CSVD总体负担与LAA型卒中患者转归密切相关.较高的CSVD总评分和基线NIHSS评分与LAA型卒中患者90 d时转归不良独立相关.Objective To investigate the relationship between the total burden of cerebral small vessel disease （CSVD） and the outcomes in patients with large artery atherosclerotic （LAA） stroke.Methods From June 2016 to January 2018,patients with LAA stroke treated at the Department of Neurology,the Affiliated Hospital of Qingdao University were enrolled retrospectively.The overall burden of CSVD was evaluated according to MRI findings.The National Institute of Health Stroke Scale （NIHSS） was used to evaluate theseverity of stroke.The modified Rankin scale （mRS） was used to evaluate the outcomes at day 90 after the onset.The mRS score 0-2 was defined as good outcome,and 〉2 was defined as poor outcome.Results A total of 148 patients with LAA stroke were enrolled,including good outcome in 72 （48.65%） and poor outcome in 76 （51.35%）.There were significant differences in the proportions of hypertension （69.44% vs.85.52%;x2 =5.519,P =0.019）,taking antihypertensive drugs before the onset （48.61% vs.69.74%;x2 =6.845,P =0.009）,white matter hyperintensity （18.06% vs.39.47%;x2 =8.228,P =0.004）,enlarged perivascular space （33.33% vs.60.53%;x2 =10.968,P =0.001）,as well as the baseline NIHSS scores （3.00 [2.00-4.00] vs.7.0 [5.0-10.0];Z =-8.159,P =0.001）,baseline systolic blood pressure （149.40± 15.80mmHgvs.157.21± 14.05mmHg;t=3.180,P=0.002;1 mmHg=0.133 kPa）,fasting glucose （5.91 ±2.06 mmol/L vs.6.92 ±2.65 mmol/L;t =2.595,P =0.010）,and the proportions of total CSVD scores 0,1,2,3,and 4 （Z =-4.927,P =0.001） between the 2 groups.After adjustment for the confounding factors,such as hypertension and fasting glucose,multivariate regression analysis showed that the total CSVD score （odds ratio 4.457,95% confidence interval 1.768-11.236;P =0.002） and baseline NIHSS score （odds ratio 2.070,95% confidence interval 1.580-2.710;P 〈 0.001）were the independent risk factors for the poor outcomes in patients with LAA stroke.Conclusions The total CSVD burden was closely associated w

关 键 词：卒中 脑缺血 脑小血管疾病 磁共振成像 动脉粥样硬化 治疗结果 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]