摘要
目的 探讨脑小血管病(CSVD)负荷预测大血管闭塞(LVO)急性缺血性卒中(AIS)血管内治疗(EVT)预后的价值.方法 该研究为横断面研究.回顾性分析2018年2月至2022年9月在南京医科大学第一附属医院就诊并接受EVT的前循环LVO AIS患者242例的临床和影像资料.对EVT后1周内的患者随访MRI并评估CSVD征象[脑白质高信号(WMH)、血管源性腔隙、血管周围间隙、脑微出血和脑萎缩]及负荷总评分(总分0～5分),并随访EVT后90天改良Rankin量表(mRS)评分.根据CSVD负荷评分将患者分为轻度负荷组(0～1分)和中-重度负荷组(2～5分);根据EVT后90天mRS评分将患者分为预后良好组(0～2分)和预后不好组(3～6分).采用Mann-Whitney U检验、x2检验比较2组的临床及影像指标,对单因素分析中P＜0.1的变量被纳入多因素logistic回归分析筛选预测预后的独立影响因素.结果 242例患者中预后良好组169例、预后不好组73例.与预后良好组比较,预后不好组患者的年龄、高血脂发生率、基线美国国立卫生研究院卒中量表(NIHSS)评分、出血转化发生率、CSVD负荷总评分、脑室旁WMH评分3分和(或)深部WMH评分≥2分发生率、中-重度脑萎缩发生率更高,血管再通良好率更低,差异均具有统计学意义(P均＜0.05).多因素logistic分析显示高血脂史(OR=8.438,95％CI 1.691～42.119,P=0.009)、基线 NIHSS评分(OR=1.103,95％CI 1.047～1.162,P＜0.001)、EVT 后血管再通良好(OR=0.131,95％CI 0.038～0.454,P=0.001)及 EVT 后出血转化(OR=1.952,95％CI1.031～3.697,P=0.040)是LVO AIS患者EVT预后的独立影响因素.轻度负荷组157例、中-重度负荷组85例.与轻度负荷组相比,中-重度负荷组的90天mRS评分更高(Z=-2.24,P=0.025).结论 基于CSVD负荷预测前循环LVO AIS患者EVT预后具有一定的临床应用价值.
Abstract
Objective To assess the value of cerebral small vessel disease[CSVD)burden in predicting prognosis in acute ischemic stroke(AIS)patients with anterior circulation large vessel occlusion(LVO)after endovascular therapy(EVT).Methods The study was a cross-sectional study.A total of 242 patients with AIS due to anterior circulation LVO received EVT in the First Affiliated Hospital of Nanjing Medical University from February 2018 to September 2022.The clinical and imaging data of all patients were analyzed retrospectively.On follow-up MRI within 7 days after EVT,CSVD features[white matter hyperintensity(WMH),lacune,perivascular space,cerebral microbleed,cerebral atrophy]and CSVD burden score(0-5)was evaluated.Modified Rankin scale(mRS)score at 90 days after EVT was assessed.Patients were categorized into a mild burden group(0-1 points)and a moderate-severe burden group(2-5 points)based on CSVD burden score.Meanwhile,patients were categorized into a good prognosis group(0-2 points)and a bad prognosis group(3-6 points)based on mRS score at 90 days after EVT.Mann-Whitney U test and x2 test were used to compare the difference of clinical and imaging indexes between the 2 groups,and variables with P＜0.1 in the univariate analysis were included in the multifactorial logistic regression to screen for independent factors to predict the prognosis.Results There were 169 patients in the good prognosis group and 73 patients in the bad prognosis group out of 242 patients.Compared with the good prognosis group,age,incidence of hyperlipidemia,baseline National Institutes of Health Stroke Scale(NIHSS)scores,incidence of hemorrhagic conversion,CSVD burden scores,incidence of periventricular WMH scores of 3 and/or deep WMH scores≥2,and incidence of moderate-severe cerebral atrophy of patients in the bad prognosis group were higher,and the incidence of complete recanalization was lower(all P＜0.05).Multivariate analysis showed hyperlipemia(OR=8.438,95％CI 1.691-42.119,P=0.009),baseline NIHSS score(OR=1.103,95％CI 1.047-1.162,P＜O.001),complete recanalization(OR=0.131,95％CI 0.038-0.454,P=0.001)and hemorrhage transformation(OR=1.952,95％CI 1.031-3.697,P=0.040)were independent factors for the prognosis of EVT in patients with LVO AIS.There were 157 cases in the mild burden group and 85 cases in the moderate-severe burden group.The 90-day mRS score was higher in the moderate-severe burden group compared with the mild burden group(Z=-2.24,P=0.025).Conclusion CSVD burden has some clinical implications in predicting the prognosis of EVT in patients with anterior circulation LVO AIS.
维普
万方数据