CSVD总负荷与大脑中动脉供血区单发皮质下小梗死早期神经功能恶化的相关性研究  

Correlation between the total burden of cerebral small vessel disease and the early neurological deterioration of single small subcortical infarction in the middle cerebral artery territory

作　　者：任慧玲[1] 罗伟刚 杨玲[1] 步玮[2] Ren Huiling;Luo Weigang;Yang Ling;Bu Wei(Department of Neurology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院神经内科,石家庄0500511 [2]河北医科大学第三医院神经外科,石家庄0500511

出　　处：《脑与神经疾病杂志》2024年第10期641-646,共6页Journal of Brain and Nervous Diseases

基　　金：河北省医学研究课题计划(20240198)。

摘　　要：目的探讨脑小血管病(CSVD)的磁共振成像(MRI)总负荷与大脑中动脉供血区单发皮质下小梗死(SSSI)患者发生早期神经功能恶化(END)之间的关系。方法收集2020年1月-2021年12月在河北医科大学第三医院神经内科经脑MRI证实为大脑中动脉供血区SSSI患者133例。独立评估了脑MRI中的假定血管源性腔隙、脑微出血、脑白质高信号(WMH)和血管周围间隙扩大的存在,整合各CSVD影像特征,进而确定CSVD总负荷。END定义为入院后72h内美国国立卫生研究院卒中量表(NIHSS)评分增加≥2分或是肌力单项评分增加≥1分。根据患者入院后神经功能缺损程度的进展情况,将患者分为END组和非END组。比较两组的基线资料、单一CSVD影像学标志物和CSVD总负荷。采用Logistic回归分析SSSI患者中CSVD总负荷与发生END的关系。根据梗死部位对SSSI患者进行亚组分析,采用Logistic回归分析CSVD总负荷在不同梗死部位的SSSI患者中与发生END的关系。结果133例SSSI患者,其中30例(22.6%)被诊断为END。END组出现假定血管源性腔隙、脑微出血的比例、脑室周围WMH及CSVD总负荷评分显著高于非END组(P<0.05)。Logistic回归分析显示,CSVD总负荷是SSSI患者卒中后发生END的独立危险因素(P<0.05)。亚组分析结果显示远端SSSI患者的CSVD总负荷与END之间存在显著相关性(P<0.05)。结论CSVD总负荷是大脑中动脉供血区SSSI患者卒中后发生END的独立危险因素,在远端梗死上相关性更显著。Objective To investigate the relationship between total magnetic resonance imaging(MRI)burden of cerebral small vessel disease(CSVD)and early neurological deterioration(END)in patients with single small subcortical infarction(SSSI)in the middle cerebral artery territory.Methods A total of 133 patients with SSSI in the middle cerebral artery blood supply area confirmed by brain MRI in the Department of Neurology,The Third Hospital of Hebei Medical University from January 2020 to December 2021 were collected.We independently evaluated brain MRI for lacune of presumed vascular origin,cerebral microbleeds,white matter hyperintensities,and perivascular space enlargement,and integrated the imaging features of each CSVD to determine the total burden of CSVD.END was defined as an increase of≥2 points in NIHSS score or an increase of≥1 point in individual muscle strength scores within 72 hours after admission.According to the progression of neurological deficit after admission,the patients were divided into END group and non-END group.The baseline data,single CSVD imaging markers and the total burden of CSVD were compared between the two groups.Logistic regression was used to analyze the relationship between the total burden of CSVD and the occurrence of END in SSSI patients.The subgroup analysis of SSSI patients was performed according to the infarct location,and the relationship between the total burden of CSVD and the occurrence of END in SSSI patients with different infarct locations was analyzed by Logistic regression.Results Of the 133 patients with SSSI,30(22.6%)were diagnosed with END.The proportion of lacunes,cerebral microbleeds,periventricular WMH score and the total burden score of CSVD in the END group were significantly higher than those in the non-END group(P<0.05).Logistic regression analysis showed that the total burden of CSVD was an independent risk factor for END in patients with SSSI after stroke(P<0.05).The results of subgroup analysis showed that there was a significant correlation between the t

关 键 词：脑小血管病总负荷 单发皮质下小梗死 早期神经功能恶化 大脑中动脉 

分 类 号：R743.32[医药卫生—神经病学与精神病学]