Willis环完整性和脑白质变化对急性缺血性脑卒中患者神经功能缺损及预后的影响  

Effects of Willis ring integrity and white matter changes on neurological deficit and prognosis in patients with acute ischemic stroke

作　　者：秦雅鑫 任占云 李杰 许冬华 叶沈早 陈蒋楠 Qin Yaxin;Ren Zhanyun;Li Jie(Department of Rehabilitation Medicine,Yixing People's Hospital,Yixing Jiangsu 214200)

机构地区：[1]江苏省宜兴市人民医院(江苏大学附属宜兴医院)康复医学科,214200 [2]江苏省宜兴市人民医院(江苏大学附属宜兴医院)神经内科,214200

出　　处：《卒中与神经疾病》2023年第3期259-264,共6页Stroke and Nervous Diseases

基　　金：无锡市“双百”中青年医疗卫生拔尖人才项目(BJ2020108)。

摘　　要：目的探讨Willis环完整性和脑白质变化对急性缺血性脑卒中患者神经功能缺损及预后的影响。方法选取本院2018年8月-2021年2月收治的急性缺血性脑卒中患者172例,根据患者美国国立卫生院卒中量表(National institute of health stroke scale,NIHSS)评分分为轻度组(n=48)、中度组(n=74)和重度组(n=50),分析不同组别患者Willis环完整性和脑白质评分变化;所有患者均随访12个月,分析患者预后情况与Willis环完整性和脑白质评分的关系;采用Spearman分析Willis环完整性、脑白质评分与NIHSS评分、改良Rankin量表(Modified Rankin scale,mRS)评分的关系;绘制受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析相关指标对急性缺血性脑卒中不良预后的预测效能。结果经12个月随访,172例患者共有13例失访,随访成功率为92.44%(159/172);重度组Willis环完整性评分均低于轻度组、中度组(P<0.05);重度组脑室周围白质评分、深部脑白质评分均高于轻度组、中度组(P<0.05);预后不良组Willis环完整性评分低于预后良好组(P<0.05);预后不良组脑室周围白质评分、深部脑白质评分均高于预后良好组(P<0.05);经Spearman分析发现,Willis环完整性评分与NIHSS评分、mRS评分呈负相关(r=-0.492、-0.417,P=0.000);脑室周围白质评分、深部脑白质评分均与NIHSS评分和mRS评分呈正相关(r=0.513、0.450、0.508、0.427,P<0.05);ROC分析发现,三者联合预测患者预后的曲线下面积(Area under the curve,AUC)为0.922(0.853~0.991),分别高于Willis环完整性评分(AUC=0.671)、脑室周围白质评分(AUC=0.780)、深部脑白质评分(AUC=0.808)单独预测患者预后的AUC(P<0.05)。结论急性缺血性脑卒中患者Willis环完整性和脑白质变化与神经功能缺损及预后密切相关,可作为预后效果的预测指标。ObjectiveTo investigate the effects of Willis ring integrity and white matter changes on neurological deficits and prognosis in patients with acute ischemic stroke.Methods A total of 172 patients with acute ischemic stroke treated in our hospital from August 2018 to February 2021 were selected and divided into mild group(n=48),moderate group(n=74)and severe group(n=50)according to the NIHSS score.The changes in Willis ring integrity and brain white matter score in different NIHSS score groups were analyzed.All patients were followed up for 12 months.The relationship between prognosis and Willis ring integrity and brain white matter score was analyzed.Spearman's correlation was used to analyze the relationship between Willis ring integrity,brain white matter score,NIHSS score and mRS score.The ROC curve was drawn to analyze the predictive efficacy of relevant indicators on the adverse prognosis of acute ischemic stroke.Results After 12 months of follow-up,13 of 172 patients were lost to follow-up.The success rate of follow-up was 92.44%(159/172).The Willis ring integrity score in the severe group was lower than that in the mild and moderate group(P<0.05).The scores of periventricular white matter and deep white matter in the severe group were higher than those in the mild group and moderate group(P<0.05).The Willis ring integrity score in the poor prognosis group was lower than that in the good prognosis group(P<0.05).The periventricular white matter score and deep brain white matter score in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Spearman analysis showed that the Willis ring integrity score was negatively correlated with the NIHSS score and mRS score(r=-0.492,-0.417,P=0.000).The periventricular white matter score and deep brain white matter score were positively correlated with the NIHSS score and mRS score(r=0.513,0.450,0.508,0.427,P<0.05).ROC curve analysis showed that the AUC of prognosis predicted by the combination of the three was 0.922(0.853~0.991),which was hig

关 键 词：急性缺血性脑卒中 脑白质 Willis环完整性 神经功能 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]