头颈部动脉粥样硬化狭窄与急性缺血性脑卒中患者7d神经功能恶化的相关性  

Correlation between craniocervical atherosclerotic stenosis and 7-day neurologic deterioration of patients with acute ischemic stroke

作　　者：何悦[1] 徐宇浩[1] 杨溢[1] 于明[1] HE Yue;XU Yuhao;YANG Yi;YU Ming(Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院,江苏镇江212001

出　　处：《中国实用神经疾病杂志》2021年第19期1703-1712,共10页Chinese Journal of Practical Nervous Diseases

基　　金：镇江市社会发展科技计划项目(编号:SH2019036);2021年江苏省妇幼保健协会科研项目(编号:FYX202006)。

摘　　要：目的将早期神经功能恶化(neurologic deterioration,ND)的评估时间由既往24-72 h延长至7 d,分析头颈部动脉粥样硬化狭窄(atherosclerotic stenosis,AS)与7 d ND的相关性。方法连续纳入241例急性缺血性脑卒中(acute ischemic stroke,AIS)患者,根据入院后第1、3、7天的美国国立卫生研究院卒中量表(NIHSS)评分将AIS患者分为稳定组、缓解组和ND组;利用磁共振血管成像(magnetic resonance angiography,MRA)评估颅内AS,彩色多普勒超声评估颅外AS,将AS≥50%定义为狭窄或闭塞,探讨各组头颈部AS的分布和位置等特征。结果多因素Logistic回归分析发现,以稳定组作为参照,头颈部AS总数(OR=0.32,95%CI 0.14-0.73,P=0.006)可负性独立预测7 d ND;AS位于基底动脉(basilar artery,BA)(OR=1.93,95%CI 1.14-2.51,P=0.006)可正性独立预测7 d ND;AS位于双侧椎动脉颅内段(intracranial vertebral artery,I-VA)(OR=0.045,95% CI 0.006-0.36,P<0.001)可负性独立预测7 d症状缓解。结论AIS患者头颈部AS总数和颅内后循环动脉粥样硬化狭窄(posterior circulation atherosclerotic stenosis,PCAS)与7 d ND独立相关,AS位于I-VA可独立预测7 d ND与7 d症状缓解,可为颅内PCAS患者治疗方案选择提供理论基础。Objective To analyze the correlation of craniocervical atherosclerotic stenosis(AS)with neurologic deterioration(ND)by prolonging the evaluated time of early ND from 24-72 hours in previous studies to 7 days.MethodsTotally 241 consecutive patients with acute ischemic stroke(AIS)were enrolled.Patients were dived into stable group,relieve group and ND group based on National Institute of Health stroke scale(NIHSS)at1 d,3 d,7 d after admission.Intracranial major arteries were evaluated by magnetic resonance angiography(MRA)and extracranial major arteries were evaluated by Doppler ultrasound.Atherosclerotic stenosis was defined as≥50%stenosis or occlusion.Craniocervical AS characteristics of 3 groups,including distribution and site,were investigated.ResultsIn multivariate Logistic regression analysis,using stable group as reference,craniocervical total AS number(OR=0.32,95% CI:0.14-0.73,P=0.006)can negatively predict 7 d ND.Basilar artery AS(OR=1.93,95%CI:1.14-2.51,P=0.006)can positively predict 7 d ND,whereas bilateral intracranial vertebral artery(I-VA)AS(OR=0.045,95%CI:0.006-0.36,P<0.001)can negatively predict 7 d relief.ConclusionCraniocervical total AS number and intracranial posterior circulation atherosclerotic stenosis(PCAS)of AIS patients was independly corralated with 7 d ND,respectively.I-VA AS can independly predict both 7 d ND and 7 d relief.The present study could provide theoretical foundation for therapeutic option of intracranial PCAS.

关 键 词：急性缺血性脑卒中 动脉粥样硬化 后循环动脉粥样硬化狭窄 神经功能恶化 独立预测因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]