CSVD总负荷评分在急性缺血性卒中患者静脉溶栓中的应用价值  

The value of total cerebral small vessel disease score in intravenous thrombolysis in patients with acute ischemic stroke

作　　者：卓子良 卓颖 聂志余[3] 尤年兴 刘晖 赵宗波 仲伟 张秋 ZHOU Ziliang;ZHOU Ying;NIE Zhiyu;et al(The Fifth Clinical Medical College of Yangzhou University Department of Neurology,Changshu Second People’s Hospital,Changshu 215500,China)

机构地区：[1]扬州大学第五临床医学院,常熟市第二人民医院神经内科,江苏常熟215500 [2]苏州大学附属第一医院,江苏苏州215000 [3]同济大学附属同济医院神经内科,上海201000

出　　处：《中风与神经疾病杂志》2021年第10期1098-1101,共4页Journal of Apoplexy and Nervous Diseases

基　　金：苏州市“科教兴卫”青年科技项目(No.KJXW2020066);常熟市第二人民医院院级科技项目(No.CSEY2021067)。

摘　　要：目的探讨急性缺血性卒中(acute ischemic stroke,AIS)患者脑小血管病(cerebral small vessel disease,CSVD)总体负荷在不同严重程度AIS静脉溶栓中的应用价值并寻找最优人群。方法回顾性纳入2016年3月-2020年1月188名就诊于常熟市第二人民医院神经内科接受阿替普酶静脉溶栓治疗的急性缺血性卒中患者。根据头部MRI评估CSVD总体负荷(CSVD总负荷评分),使用多因素Logistic回归分析AIS静脉溶栓患者90 d预后不良(mRS评分≥3分)的独立影响因素。应用受试者工作特征(receiver operating characteristic,ROC)曲线比较评分量表对不同人群的预测价值。结果多因素回归分析发现,糖尿病(OR=2.828,95%CI 1.009~7.924,P=0.048)、吸烟(OR=9.396,95%CI 2.690~32.823,P<0.001)、心房颤动(OR=8.160,95%CI 2.167~30.729,P=0.002)、基线NIHSS评分(每增加1分:OR=1.379,95%CI 1.241~1.532,P<0.001)、CSVD总负荷评分≥3分(OR=5.448,95%CI 1.720~17.260,P=0.004)是AIS患者静脉溶栓预后不良的独立危险因素。ROC曲线分析提示CSVD总负荷评分对8≤NIHSS≤15人群预测效果最好(C值=0.828)。结论CSVD总负荷评分≥3分是静脉溶栓患者90 d不良预后的独立危险因素,对中重度AIS静脉溶栓患者90 d预后的预测价值最高。Objective To explore the value of the overall burden of cerebral small vessel disease( CSVD) in AIS patients treated with intravenous thrombolysis and find the optimal population. Methods We retrospectively included 188 AIS patients who received intravenous thrombolysis with rt-PA in the Department of Neurology,Changshu Second People’s Hospital from March 2016 to January 2020. The total CSVD load was assessed based on 3. 0 MRI. Multivariate logistic regression was used to analyze the influencing factors associated with 90 d poor prognosis( mRS score≥3). The predictive value of the score in different groups of patients were compared by ROC curve. Results Multivariate analysis showed: diabetes( OR = 2. 828,95% CI 1. 009 to 7. 924,P = 0. 048),smoking( OR = 9. 396,95% CI 2. 690 to 32. 823,P < 0. 001),atrial fibrillation( OR = 8. 160,95% CI 2. 167 to 30. 729,P = 0. 002),baseline NIHSS score( for each additional point: OR =1. 379,95% CI 1. 241 to 1. 5320,P < 0. 001),total CSVD score ≥3 points( OR = 5. 448,95% CI 1. 720 to 17. 260,P =0. 004) were independent risk factors for poor prognosis in AIS patients treated with intravenous thrombolysis. ROC curve analysis shows that when 8≤NIHSS≤15,the CSVD total load score has a better predictive effect( C = 0. 828). Conclusion The total CSVD score≥3 points is an independent risk factor for the poor prognosis of patients with intravenous thrombolysis at 90 days. And the score had the highest predictive value for patients with moderate to severe stroke.

关 键 词：急性缺血性卒中 脑小血管病总负荷评分 静脉溶栓 转归预测 最优人群 

分 类 号：R743.3[医药卫生—神经病学与精神病学]