脑白质高信号与近期皮质下小梗死患者远期卒中复发的相关性  

Association of white matter hyperintensities with long-term stroke recurrence in patients with recent subcortical small infarcts

作　　者：木晓慧 王菲[1,2] 刘婷婷 曹树刚[2] 夏明武 王嵘峰[1,2] Mu Xiaohui;Wang Fei;Liu Tingting;Cao Shugang;Xia Mingwu;Wang Rongfeng(Department of Neurology,Hefei Second People's Hospital Affiliated to Bengbu Medical College,Hefei 230011,China;Department of Neurology,Hefei Second People's Hospital,Hefei 230011,China)

机构地区：[1]蚌埠医学院附属合肥市第二人民医院神经内科,合肥230011 [2]合肥市第二人民医院神经内科,合肥230011

出　　处：《国际脑血管病杂志》2024年第1期15-21,共7页International Journal of Cerebrovascular Diseases

基　　金：合肥市卫生健康委员会应用医学研究项目(Hwk2022zd004)。

摘　　要：目的探讨脑白质高信号(white matter hyperintensities,WMHs)与近期皮质下小梗死(recent small subcortical infarcts,RSSIs)患者远期卒中复发的相关性。方法连续性收集2019年1月至2022年8月期间在安徽医科大学附属合肥医院神经内科住院治疗且符合RSSIs临床及影像学表现的患者。收集人口统计学特征、基线临床资料和MRI特征。以卒中复发为终点事件,记录复发时间,使用Cox回归分析影响RSSIs患者卒中复发的相关因素。结果共纳入202例患者,男性138例(68.3%),年龄(67.9±10.5)岁;轻度WMHs 77例(38.1%),中度WMHs 64例(31.7%),重度WMHs 61例(30.2%)。不同WMHs严重程度组年龄、既往卒中史、高血压、高脂血症、总胆固醇、梗死灶层厚和梗死灶分布部位差异有统计学意义(P均<0.05)。中位随访时间40.5个月(四分位数间距:27.7~49.0个月),共55例(27.2%)患者出现卒中复发(缺血性卒中54例,枕叶出血1例)。轻度、中度和重度WMHs组卒中复发率分别为18.2%、31.3%和34.4%。Cox回归分析显示,WMHs是卒中复发的独立危险因素(与轻度组比较,重度组风险比2.225,95%置信区间1.116~4.436;P=0.023)。结论RSSIs患者远期卒中复发风险与WMHs严重程度相关。ObjectiveTo investigate the association of white matter hyperintensities(WMHs)with long-term stroke recurrence in patients with recent subcortical small infarcts(RSSIs).MethodsConsecutive patients admitted to the Department of Neurology,Hefei Hospital Affiliated to Anhui Medical University between January 2019 and August 2022 and met the clinical and imaging manifestations of RSSIs were collected.The demographic characteristics,baseline clinical data,and MRI features were collected.Using stroke recurrence as the endpoint event,the recurrence time was recorded,and Cox regression model was used to analyze relevant factors affecting stroke recurrence in patients with RSSIs.ResultsA total of 202 patients were enrolled,including 138 males(68.3%),aged 67.9±10.5 years.Seventy-seven patients(38.1%)were mild WMHs,64(31.7%)were moderate WMHs,and 61(30.2%)were severe WMHs.There were statistically significant differences in age,history of stroke,hypertension,hyperlipidemia,total cholesterol,infarct thickness,and infarct distribution among different WMHs severity groups(all P<0.05).The median follow-up time was 40.5 months(interquartile range,27.7-49.0 months),and a total of 55 patients(27.2%)had stroke recurrence(ischemic stroke 54,occipital hemorrhage 1).Recurrence rates of stroke in the mild,moderate,and severe WMHs groups were 18.2%,31.3%,and 34.4%,respectively.Cox regression analysis showed that WMHs were an independent risk factor for stroke recurrence(compared to the mild group,the risk ratio of the severe group was 2.225,95%confidence interval was 1.116-4.436;P=0.023).ConclusionThe risk of long-term stroke recurrence in patients with RSSI is associated with the severity of WMHs.

关 键 词：脑小血管疾病 脑梗死 白质 卒中 复发 磁共振成像 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]