脑小血管病总体负担对大脑中动脉供血区分支动脉粥样硬化病预后的影响  

Effect of total burden of cerebral small vessel disease on outcomes of brach atheromatous disease in middle cerebral artery territory

作　　者：曹志勇[1] 黄国祥[1] 李新玲[1] 朱向阳[1] CAO Zhiyong;HUANG Guoxiang;LI Xinling;ZHU Xiangyang(Department of Neurology,the Second Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学第二附属医院神经内科

出　　处：《中国实用神经疾病杂志》2019年第23期2591-2598,共8页Chinese Journal of Practical Nervous Diseases

基　　金：南通市科技计划项目(编号:MS120170041)

摘　　要：目的探讨脑小血管病(CSVD)总体负担对大脑中动脉供血区分支动脉粥样硬化病(brach atheromatous disease,BAD)预后的影响。方法收集2015-01-2019-03于南通大学第二附属医院神经内科住院治疗的大脑中动脉供血区BAD患者。应用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)、改良的Rankin量表(Modified Rankin Scal,mRS)评估患者90 d后的神经功能缺损的情况,以mRS>2分为预后不良。收集预后良好组和预后不良组的人口统计学和临床资料,应用3.0T磁共振(T1加权成像、T2加权成像、液体衰减反转恢复序列、弥散加权成像、磁敏感成像、血管成像)对所有入选患者进行CSVD影像学总体负担评估,计算CSVD总体负担评分。采用多因素Logistic回归分析确定可以影响患者预后的因素。结果共纳入BAD患者121例,男69例(57%),女52例(43%),年龄49~81(64.97±7.34)岁,NIHSS评分(7.10±2.12)分。其中预后良好组73例(60.3%),预后不良组48例(39.7%)。预后不良组高血压占比高于预后不良组[81.2%对73.9%,χ^2=2.954,P<0.05];预后不良组基线收缩压高于预后良好组[(156.6±25.4)mmHg对(145.3±28.5)mmHg,t=2.602,P<0.05];预后不良组空腹血糖高于预后良好组[(7.52±2.64)mmol/L对(6.11±2.32)mmol/L,t=2.965,P<0.05];预后不良组CSVD总体负担评分明显高于预后良好组[(3.56±0.62)分对(1.48±0.93)分;t=-13.669,P<0.05]。在校正混杂因素后,多因素回归分析显示,CSVD总体负担的评分与BAD患者的预后(OR=3.126,95%CI 1.289~10.783;P<0.05)具有独立相关性。结论 CSVD总体负担是影响大脑中动脉供血区BAD预后的独立危险因素。Objective To explore the effct of overall burden of cerebral small vascular diseases(CSVD) on the outcomes of branch atheromatous disease(BAD) in the middle cerebral artery(MCA).Methods Patients with BAD in MCA territory were collected from those admitted in the neurology department of the Second Affiliated Hospital of Nantong University between January 2015 and March 2019.NIHSS(National Institute of Health Stroke Scale) and mRS(Modified Rankin Scale) were used to evaluate the neurological impairment of the patients after 90 days,mRS>2 were defined as poor outcome.The demographic and clinical data were collected from the good outcome group and poor outcome group.And 3.0 T MRI(T1 weighted imaging,T2 weighted imaging,liquid-attenuated inversion recovery sequence,diffusion weighted imaging,susceptibility weighted imaging and magnetic resonance angiography) were used to evaluate the total burden of CSVD and calculate the total burden score of CSVD.Multivariate logistic regression analysis were used to determine the independent influencing factors that could affect the outcomes of patients.Results A total of 121 BAD patients were enrolled,including 69 males(57%) and 52 females(43%),aging from 49 to 81 years,with an average age of(64.97±7.34) years and an average NIHSS score of(7.10±2.12) points.There were 73 cases(60.3%) in the good outcome group and 48 cases(39.7%) in the poor outcome group.The proportion of hypertension in the poor outcome group was higher than that in the good outcome group(81.2% vs 73.9%,χ^2=2.954,P<0.05).And there were significant differences between the poor outcome group and the good outcome group in baseline systolic blood pressure((156.6±25.4) mmHg vs(145.3±28.5) mmHg,t=2.602,P<0.05) and fasting blood glucose((7.52±2.64) mmol/L vs(6.11±2.32) mmol/L,t=2.965,P<0.05).The total burden score of CSVD in the poor outcome group was significantly higher than that in the good outcome group((3.56±0.62) points vs (1.48±0.93) points;t=-13.669,P<0.05).After adjusting for confounding factors,multiv

关 键 词：脑小血管病 分支动脉粥样硬化病 脑卒中 预后 影响因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]