Willis环及脑白质变化对急性缺血性脑卒中静脉溶栓患者预后的影响  

Effects of the circle of Willis and white matter lesions on the prognosis of patients with acute ischemic stroke trea-ted with intravenous thrombolysis.

作　　者：张润声 吴小燕 郭建军 江瑞信 刘志锋 雷炳喜[4] ZHANG Run-sheng;WU Xiao-yan;GUO Jian-jun;JIANG Rui-xin;LIU Zhi-feng;LEI Bing-xi(Department of Internal Medicine,Zengcheng District People′s Hospital of Guangzhou,Guang-zhou 511300,Guangdong,China;不详)

机构地区：[1]广州市增城区人民医院内科,广东广州511300 [2]广州市增城区人民医院神经内科,广东广州511300 [3]广州市增城区人民医院影像科,广东广州511300 [4]中山大学孙逸仙纪念医院神经外科,广东广州510120

出　　处：《广东医学》2020年第16期1659-1663,共5页Guangdong Medical Journal

摘　　要：目的探讨急性缺血性脑卒中患者Willis环的形态特征与脑白质病变(WML)关系,分析两指标对静脉溶栓预后1年的影响.方法收集分析急性缺血性脑卒中静脉溶栓患者发病时Willis环形态特征与WML关联性,并观察其溶栓1年后的预后情况,同时纳入溶栓预后危险因素进行多因素logistic回归分析.结果本研究患者232例,男172例,女60例,不同部位Willis环变异的WML评分高于Willis环完整组(F=5.594,P=0.003).影响患者1年预后不良(复发/死亡)的危险因素包括:WML评分(rs=0.155,P=0.018)、Willis变异(rs=0.162,P=0.014)、溶栓前血糖(rs=0.147,P=0.030).logistic逐步回归分析显示WML评分(95%CI 1.003~1.432)、Willis变异(95%CI 1.032~3.497)是急性缺血性脑卒中溶栓患者1年预后不良的相关危险因素.结论Willis环变异和WML是急性缺血性卒中静脉溶栓后1年预后的不良(复发/死亡)危险因素.Objective To retrospectively investigate the correlation between the Circle of Willis and white matter lesion(WML)in acute ischemic stroke patients treated with intravenous thrombolysis,and their influences on the 1-year prognosis of thrombolysis treatment.Methods A total of 232 ischemic stroke patients who accepted rt-PA treatment were enrolled in this study.All the patients received head MRI including MRA.The variation of Circles of Willis were di-vided into complete,part complete and incomplete groups according to Krubbe-Hartkam classification,and the value of WML were classified by Fazekas scales.The poor outcome for 1-year prognosis of intravenous thrombolysis with rt-PA were defined as recurrence of ischemic stroke or death during 1-year follow-up after onset.The Circle of Willis,WMLs and other risk factor was set as dependent variable for analyzed by multivariable Logistic regression analysis.Results The value of WML in incomplete Willis Loop group was signifcantly higher than complete group.The risk factor for the intrave-nous thrombolysis treatment within 1 year include were WML value(rs=0.155,P=0.018),Circle of Willis variation(rs=0.162,P=0.014),and blood glucose on admission(rs=0.147,P=0.030).Multivariable Logistic regression a-nalysis showed WML value(OR95%CI=1.003-1.432)and Circle of Willis variation(OR95%CI=1.032-3.497)were the independent risk factors for the 1-year prognosis of intravenous thrombolysis.Conclusion WML value and Cir-cle of Willis variation are the independent risk factor for prognosis of intravenous thrombolysis.

关 键 词：WILLIS环 脑白质病变 急性缺血性脑卒中 静脉溶栓 预后 

分 类 号：R739.41[医药卫生—肿瘤] R743.3[医药卫生—临床医学]