脑白质高信号与急性缺血性脑卒中静脉溶栓后早期神经功能恶化的相关性研究  

Correlation between white matter hyperintensity and early neurological deterioration after intravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke patients

作　　者：刘雪云 方琪[2] 吴小三[1] 严孙宏[1] 王龙[1] 方传勤[1] Liu Xueyun;Fang Qi;Wu Xiaosan;Yan Sunhong;Wang Long;Fang Chuanqin(Department of Neurology,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of Neurology,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]安徽医科大学第二附属医院神经内科,合肥230601 [2]苏州大学附属第一医院神经内科,苏州215006

出　　处：《中华神经医学杂志》2022年第3期257-262,共6页Chinese Journal of Neuromedicine

基　　金：国家自然科学基金面上项目(82071300)。

摘　　要：目的探讨脑白质高信号(WMH)的严重程度、不同病变区域对急性缺血性脑卒中(AIS)患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后早期神经功能恶化(END)的影响。方法选择安徽医科大学第二附属医院神经内科自2019年4月至2021年7月收治的373例AIS患者进入研究,所有患者均在发病4.5 h内接受rt-PA静脉溶栓治疗。根据是否出现END将患者分为END组(89例)与无END组(284例)。选择Fazekas量表对2组患者脑室旁及皮质下WMH进行评分,0~1分定义为无-轻度脑室旁WMH(PVWMH)/皮质下WMH(SCWMH),2~3分定义为中-重度PVWMH/SCWMH;计算2个部位评分之和,0~2分定义为无-轻度WMH,3~6分定义为中-重度WMH。采用单因素分析比较2组患者基线资料并运用多因素Logistic回归分析明确WMH病变区域及严重程度与END的相关性。结果单因素分析结果显示:2组患者在年龄、基线血糖、基线美国国立卫生研究院卒中量表(NIHSS)评分、TOAST分型、溶栓后出血转化、PVWMH、SCWMH及WMH评分等方面差异有统计学意义(P<0.05)。而多因素Logistic回归分析结果显示:仅基线NIHSS评分(OR=1.064,95%CI:1.019~1.111,P=0.005)、溶栓后出血转化(OR=3.931,95%CI:2.007~7.701,P=0.000)及中-重度WMH(OR=4.736,95%CI:2.737~8.195,P=0.000)、中-重度SCWMH(OR=5.557,95%CI:3.156~9.783,P=0.000)与END的发生独立相关。结论中-重度SCWMH、中-重度WMH患者及出现溶栓后出血转化的高NIHSS评分患者更易出现END。Objective To investigate the effects of white matter hyperintensity(WMH)of different lesion areas and severities on early neurological deterioration(END)in acute ischemic stroke(AIS)patients after intravenous recombinant tissue plasminogen activator(rt-PA)thrombolysis.Methods Three hundred and seventy-three AIS patients,admitted to our hospital from April 2019 to July 2021,were chosen in our study.These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset.According to the presence or absence of END,these patients were divided into END group(n=89)and non-END group(n=284).Fazekas scale was used to assess the periventricular WMH(PVWMH)and subcortical WMH(SCWMH):none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores;the sum scores of the two sites were calculated,and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores.Univariate analysis was used to compare the baseline data of the two groups,and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities.Results Univariate analysis showed that there was significant difference between the END group and non-END group in age,baseline blood glucose,baseline National Institutes of Health Stroke Scale(NIHSS)scores,Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification,hemorrhagic transformation after thrombolysis,and PVWMH,SCWMH,and WMH scores(P<0.05).Multivariate Logistic analysis showed that only baseline NIHSS scores(OR=1.064,95%CI:1.019-1.111,P=0.005),hemorrhagic transformation after thrombolysis(OR=3.931,95%CI:2.007-7.701,P=0.000),moderate-severe WMH(OR=4.736,95%CI:2.737-8.195,P=0.000),and moderate-severe SCWMH(OR=5.557,95%CI:3.156-9.783,P=0.000)were independently related to the occurrence of END.Conclusion Patients with moderate-severe SCWMH,moderate-severe WMH,or high NIHSS scores after thrombolysis trend to have END.

关 键 词：脑白质高信号 脑白质疏松 急性缺血性脑卒中 静脉溶栓 早期神经功能恶化 

分 类 号：R743.3[医药卫生—神经病学与精神病学]