腔隙性脑梗死合并脑微出血的危险因素与脑白质病变的相关性

目的 探讨腔隙性脑梗死(LI)合并脑微出血(CMBs)的危险因素及与脑白质病变(WML)的关系。方法 于2020年3月至2022年6月在海南省老年病医院收集LI患者134例,根据磁敏感加权成像(SWI)检测CMBs,分为CMBs组(49例)和非CMBs组(85例),利用脑白质病变量表评分(WMLs)分析LI患者脑白质病情情况与CMBs相关性,采用Logistic回归模型分析LI患者并发CMBs的危险因素。结果 134例LI患者合并CMBs发生率为36.57%(49/134例)。CMBs组WML发生率、WMLs评分明显高于非CMBs组(P<0.05);多因素Logistic回归分析显示,血尿酸、高血压史、高密度脂蛋白(HDL)、WML发生率和WMLs评分是LI患者发生CMBs的独立影响因素。且CMBs病灶数量与WMLs评分存在明显正相关(r=0.412,P<0.05)。结论 LI患者发生CMBs发生影响因素众多,控制血压、血脂水平以及降低血尿酸对于预防LI患者发生CMBs具有重要意义,且脑白质病变程度与CMBs严重程度紧密相关。     

偏头痛伴发脑微出血的相关危险因素分析

目的分析偏头痛患者伴发脑微出血(CMBs)的临床特点及影响因素。方法连续收集178例临床确诊的偏头痛患者,根据头颅MRI有无CMBs表现分为两组,收集患者一般资料,头痛特点并进行比较。结果 (1)178例偏头痛患者中CMBs患者56例,偏头痛合并CMBs发生率为31.5%,其中单发病灶17例(30.4%),多发病灶39例(69.6%),单纯脑叶病灶31例(55.4%);(2)与无CMBs的偏头痛患者比较,合并CMBs的偏头痛患者更容易合并高血压(P=0.028),头痛病程长(P=0.002)、头痛发作频率高(P=0.001)且容易伴发先兆(P=0.036);(3)多因素Logistic回归分析显示,在校正年龄、性别及其他危险因素后,头痛病程(OR=1.166,95%CI:1.044~1.303,P=0.007)、头痛发作频率(OR=1.353,95%CI:1.116~1.640,P=0.002)和先兆偏头痛(OR=10.080,95%CI:1.630~62.329,P=0.013)与偏头痛发生CMBs相关。结论偏头痛病程长、发作频率高及伴有先兆是偏头痛发生CMBs的危险因素。     

腔隙性脑梗死脑白质病变与脑微出血的相关性研究

目的探讨腔隙性脑梗死(LI)患者脑白质病变(WML)表现与脑微出血(CMBs)的关系。方法回顾性分析我院129例LI患者临床资料,根据CMBs病情程度将患者分为无出血组(n=20)、轻度组(n=60)、中度组(n=37)及重度组(n=12)。比较不同分组患者一般资料和实验室检测指标水平,分析CMBs与脑白质病变量表评分(WMLs)的相关性,采用Logistic多因素分析法分析LI患者WML和CMBs合并发病的相关因素。结果不同CMBs病情程度患者年龄和高血压合并症发生情况比较,差异有统计学意义(P<0.05)。不同CMBs病情程度患者血清HDL-C、LDL-C、hs-CRP、Hcy、CIMT及颈动脉斑块积分水平比较,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,年龄、高血压、HDL-C、Hcy及CIMT是影响LI患者WML与CMBs合并发病的独立危险因素(P<0.05)。结论LI患者WML严重程度与CMBs病变程度呈正相关,年龄增长、高血压史、低水平HDL-C、高水平Hcy及CIMT增加是影响LI患者WML与CMBs合并发病的独立危险因素。     

帕金森病患者脑微出血相关危险因素分析

目的探讨帕金森病(PD)患者脑微出血(CMBs)的相关危险因素。方法收集128例完成磁敏感加权成像(SWI)序列的原发性PD患者的临床资料,并进行分析。结果 15.6%的PD患者合并CMBs,其中单纯脑叶CMBs占55%,深部或幕下CMBs占45%。CMBs组年龄、高血压及使用抗血小板药物比率显著高于无CMBs组(P0.05～0.01)。二元Logisitic回归分析显示,年龄(OR=1.084,95%CI:1.023～1.149,P=0.007)、高血压(OR=3.210,95%CI:1.129～9.198,P=0.030)是PD合并CMBs的独立危险因素。单纯脑叶CMBs组年龄、病程显著高于非单纯脑叶CMBs组(P0.05～0.01)。二元Logisitic回归分析显示,年龄是PD患者合并单纯脑叶CMBs的独立危险因素(OR=1.121,95%CI:1.035～1.214,P=0.005)。深部或幕下CMBs组高血压比率显著高于非深部或幕下CMBs组(P0.05)。二元Logisitic回归分析显示,高血压是PD患者合并深部或幕下CMBs的独立危险因素(OR=6.027,95%CI:1.459～26.40,P=0.013)。结论年龄、高血压是PD患者CMBs发生的危险因素,控制高血压可能可以减少早中期PD患者CMBs的发生。     

腔隙性脑梗死脑白质病变与脑微出血的相关性研究

目的探讨腔隙性脑梗死(LI)患者脑白质病变(WML)表现与脑微出血(CMBs)的关系。方法回顾性分析我院129例LI患者临床资料,根据CMBs病情程度将患者分为无出血组(n=20)、轻度组(n=60)、中度组(n=37)及重度组(n=12)。比较不同分组患者一般资料和实验室检测指标水平,分析CMBs与脑白质病变量表评分(WMLs)的相关性,采用Logistic多因素分析法分析LI患者WML和CMBs合并发病的相关因素。结果不同CMBs病情程度患者年龄和高血压合并症发生情况比较,差异有统计学意义(P<0.05)。不同CMBs病情程度患者血清HDL-C、LDL-C、hs-CRP、Hcy、CIMT及颈动脉斑块积分水平比较,差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示,年龄、高血压、HDL-C、Hcy及CIMT是影响LI患者WML与CMBs合并发病的独立危险因素(P<0.05)。结论LI患者WML严重程度与CMBs病变程度呈正相关,年龄增长、高血压史、低水平HDL-C、高水平Hcy及CIMT增加是影响LI患者WML与CMBs合并发病的独立危险因素。     

缺血性脑卒中患者合并脑微出血的危险因素分析

目的探讨缺血性脑卒中(cerebral ischemic stroke,IS)患者合并脑微出血(cerebral microbleeds,CMBs)的危险因素。方法回顾性收集2015年1月至2017年5月作者医院神经内科连续收治的IS住院患者1631例,根据是否存在CMBs分为合并CMBs组703例和未合并CMBs组928例。分析两组间性别构成、年龄、血压、体重、体重指数(body mass index,BMI)、血糖、尿酸、三酰甘油(triglycerides,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-c)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-c)、载脂蛋白A(apolipoproteins A,apoA)、载脂蛋白B(apolipoproteins B,apoB)、吸烟史、饮酒史、高血脂史、糖尿病史、高血压史、心脏疾病史、脑白质高信号(white matter hyperintensity,WMH)的差异,并采用多因素Logistic回归分析影响IS患者发生CMBs的危险因素。结果与未合并CMBs组比较,合并CMBs组患者年龄大,男性、吸烟、饮酒、高血压、糖尿病、WMH构成比例高,空腹血糖、尿酸水平高(均P<0.05),而空腹LDL-c和apoA水平较低(均P<0.05)。多因素Logistic回归分析显示吸烟(OR=5.791,95%CI:3.714~9.031,P<0.01)、饮酒(OR=7.306,95%CI:4.926~10.835,P<0.01)、高血压(OR=2.162,95%CI:1.487~3.143,P<0.01)、WMH(OR=3.249,95%CI:1.594~6.625,P<0.01)、LDL-c(OR=0.789,95%CI:0.630~0.989,P<0.05)、apoA(OR=0.696,95%CI:0.369~0.753,P<0.01)是IS合并CMBs的独立危险因素。结论吸烟、饮酒、高血压、WMH、LDL-c、apoA是IS合并CMBs的独立危险因素,且LDL-c和apoA水平下降与CMBs发生增加相关。     

血清基质金属蛋白酶-2在脑白质病变患者头颅MRI各分级中的表达水平

目的探讨血清基质金属蛋白酶-2(MMP-2)在脑白质病变(WML)患者头颅MRI各分级中的表达水平。方法选取WML患者60例为病例组和无WML患者30例为对照组。收集临床资料,并检测血清MMP-2水平。结果血清MMP-2水平在对照组分别与WMLⅠ级、WMLⅡ级、WMLⅢ级之间比较差异均有统计学意义(均P0.001);血清MMP-2水平在WMLⅠ级分别与WMLⅡ级、WMLⅢ级之间比较差异均有统计学意义(均P0.001),血清MMP-2水平在WMLⅡ级与WMLⅢ级之间比较无统计学差异(P0.05)。经有序Logistic回归分析,结果显示年龄(OR=2.144,95%CI:1.248~3.684,P=0.006)、血浆同型半胱氨酸(Hcy)水平(OR=4.432,95%CI:1.344~14.600,P=0.014)、MMP-2(OR=7.622,95%CI:4.063~14.296,P=0.001)与WML严重程度相关。结论 MMP-2可能是WML发病机制中的关键因素之一,血清MMP-2水平与WML严重程度具有相关性。     

缺血性卒中患者二级预防相关脑微出血形成的危险因素分析

目的 探讨缺血性卒中患者二级预防时脑微出血(CMBs)形成的危险因素,为脑血管病的防治提供依据和指导.方法 收集明确诊断为急性缺血性卒中的患者,且在应用抗血小板聚集药物治疗4 d内完成磁敏感加权成像(SWI)检查,对纳入的患者随访12个月,12个月后复查SWI,记录随访前后CMBs的数量和部位.结果 共纳入了94例患者,其中发现伴CMBs患者50(53.2%)例,经二分类Logistics回归分析发现:高血压病史(OR=1.2,95%CI=1.07~1.61,P=0.004)、年龄(OR=2.2,95%CI=1.25~3.92,P=0.006)是CMBs形成的独立危险因素,且年龄每增加10岁,CMBs患病率增加2.2倍,经ROC曲线分析发现:年龄曲线下面积为0.695(95%CI=0.588~0.802),年龄预测CMBs的最佳cutoff值为62岁,当患者年龄≥62岁时,发生CMBs的风险明显增高.在12个月的随访中有22例患者复查SWI检查,发现新增CMBs病灶33个,经Wilcoxon非参数配对秩和检验结果显示随访后CMBs数量的中位数是2.5个,基线时是1个(Z=-3.1,P=0.002),随访前后CMBs数量差异有统计学意义.结论 对于年龄≥62岁、高血压病史、规律应用抗血小板聚集药物的缺血性卒中患者,应定期监测CMBs的数量和部位,以指导二级预防治疗方案.     

急性缺血性脑卒中静脉溶栓患者并发卒中相关性肺炎的危险因素分析

目的研究经静脉溶栓治疗后的急性缺血性脑卒中(AIS)患者并发卒中相关性肺炎(SAP)的危险因素。方法回顾性纳入本院2016年1月-2020年12月收治的经阿替普酶静脉溶栓治疗的798例AIS患者为研究对象,按是否发生SAP分为肺炎组和非肺炎组。比较两组患者临床资料,采用多因素Logistic回归分析SAP的危险因素。结果 798例静脉溶栓的AIS患者中,有115例并发SAP。多因素Logistic回归分析显示年龄≥70岁(OR=2.846,95%CI 2.311～5.083,P 0.001)、糖尿病(OR=2.291,95%CI 1.601～3.945,P=0.003)、慢性阻塞性肺疾病(OR=2.064,95%CI 1.759～3.528,P=0.005)、入院时NIHSS评分 8分(OR=1.814,95%CI 1.502～2.452,P=0.001)、意识障碍(OR=2.325,95%CI 2.005～3.404,P=0.008)、吞咽障碍(OR=2.457,95%CI 2.221～4.017,P 0.001)、出血转化(OR=1.828,95%CI 1.653～2.523,P=0.012)是AIS静脉溶栓患者并发SAP的独立危险因素。结论年龄≥70岁、糖尿病、慢性阻塞性肺疾病、入院时NIHSS评分 8分、意识障碍、吞咽障碍、出血转化是AIS静脉溶栓患者并发SAP的独立危险因素。     

外周血白细胞与急性缺血性卒中的相关性研究

目的探讨外周血早期白细胞及其亚型与急性缺血性卒中(AIS)发生、发展的关系。方法连续收集AIS住院患者588例,性别和年龄匹配的非脑卒中患者630例,比较2组患者的临床资料并进行多元Logistic回归分析。根据头颅CT或MRI梗死面积大小将AIS患者分为腔隙性AIS组151例和非腔隙性AIS组437例,比较2组白细胞参数并进行多元Logistic回归分析。结果 AIS组白细胞、中性粒细胞及中性粒细胞/淋巴细胞比值(NLR)高于对照组,差异有统计学意义(P0.05);Logistic回归分析显示,白细胞计数(OR=1.073,95%CI:1.017~1.132,P=0.009)和中性粒细胞计数(OR=1.068,95%CI:1.001~1.139,P=0.046)进入回归方程。非腔隙性AIS组白细胞计数高于腔隙性AIS组,差异有统计学意义(P0.05);Logistic回归分析显示,白细胞计数(OR=0.898,95%CI:0.811~0.995,P=0.040)进入回归方程。结论白细胞和中性粒细胞升高是AIS的独立危险因素,低白细胞计数为腔隙性AIS的危险因素,白细胞计数对AIS的发生及梗死面积具有一定的预测价值。     

The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis

It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis. Two retrospective and nine prospective studies met inclusion criteria (total 2702 patients). The overall prevalence of CMBs on pre-IVT MRI scans was 24.0%. Pre-existing CMBs on MRI scans were not significantly associated with a higher risk of early sICH (OR 1.74; 95% CI 0.91–3.33; I ² = 44.5%). Subgroup analyses did not substantially influence these associations. The presence of CMBs was associated with the increased risk of 3-month PFO (OR 1.58; 95% CI 1.08–2.31; I ² = 54.2%), PH (OR 2.14; 95% CI 1.34–3.42; I ² = 11.0%) and any ICH (OR 1.42; 95% CI 1.04–1.95; I ² = 0.0%), respectively. This meta-analysis showed that CMBs presence was not significantly associated with the increased risk of early sICH after IVT. However, the results also demonstrated that CMBs presence increased the risks of 3-month PFO, PH and any ICH after IVT. Due to a small number of included studies and methodological limitations, the results of this meta-analysis should be interpreted cautiously. CMBs presence should not be a contraindication to IVT for AIS patients based on the existing evidence.     

Prevalence and Associated Risk Factors of Cerebral Microbleeds in Egyptian Patients with Acute Ischemic Stroke and Atrial Fibrillation

BackgroundFew studies addressed the prevalence of cerebral microbleeds (CMB) and associated risk factor profile in Egyptian ischemic cerebral stroke patients with atrial fibrillation (AF).MethodsThe prevalence of CMB was estimated in 150 cases of AF ischemic stroke patients and compared to the prevalence in 150 age- and sex-matched controls of ischemic stroke patients without AF. CMB-associated risk factors were identified by comparing AF ischemic stroke patients with and without CMB. All participants were subjected to complete general, neurological examination, and magnetic resonance imaging.ResultsThe prevalence of CMBs in ischemic stroke with and without AF was 40.7% and 49.3%, respectively. Age, hypertension, diabetes mellitus, past history of stroke, antiplatelet, anticoagulant, National Institutes of Health Stroke Scale, CHA₂DS₂VASc, and white matter lesions (WML) were significant risk factors associated with CMB on univariate analysis. On multivariable logistic regression analysis, age (odds ratio [OR] 1.1, confidence interval [CI] 1.02-1.13), hypertension (OR 3.2, CI 1.19-8.81), anticoagulant (OR 3.3, CI 1.17-9.40), and WML (OR 9.6, CI 3.49-26.3) were the only independent risk factors associated with the presence of CMBs.ConclusionsAF in ischemic stroke patients was not associated with higher prevalence of CMBs. Old age, hypertension, anticoagulant treatment, and WML were the independent risk factors associated with CMB in AF ischemic stroke patients. Our results suggest that elderly hypertensive AF ischemic stroke patients maintained on anticoagulant therapy should be screened for the incidence of CMBs and monitored regularly for the development of intracerebral hemorrhage.     

The relationship between 24-hour blood pressure readings, subcortical ischemic lesions and vascular dementia

BACKGROUND: Twenty-four-hour blood pressure (BP) readings have been found to correlate with hypertensive target organ damage. Lacunar infarcts (LI) and white matter lesions (WML) probably represent manifestations of cerebral hypertensive target organ damage. This study was conducted to better delineate the relationships between 24-hour BP measurements, LI/WML and small vessel disease cognitive impairment/vascular dementia (CI/VD). METHODS: Two hundred patients with first-time symptomatic LI were examined with 24-hour BP monitoring. The degree of nocturnal BP dip, (daytime BP - nighttime BP)/daytime BP, was categorized into three groups: dippers (>0.1), nondippers (0-0.1) and reverse dippers (<0). WML were subdivided into periventricular hyperintensities (PVH) and subcortical hyperintensities. RESULTS: The breakdown of patients was: 50% nondippers, 27.5% reverse dippers and 22.5% dippers. Forty-one patients (20.5%) were found to have CI and dementia. Male sex (OR 3.35; 95% CI 1.20-9.34), advanced PVH (OR 14.42; 95% CI 5.62-36.98) and absence of a dipping status (nondipper: OR 12.62; 95% CI 1.37-115.95; reverse dipper: OR 11.95; 95% CI 1.27-112.11) were independently associated with CIVD after multivariate analysis. High nighttime systolic BP (OR 3.93; 95% CI 1.38-11.17), high daytime (OR 2.06; 95% CI 1.03-4.04) and nighttime diastolic BP (OR 2.48; 95% CI 1.13-5.45) and absence of a dipping status (nondipper: OR 2.7; 95% CI 1.03-7.05; reverse dipper: OR 3.78; 95% CI 1.38-10.34) were significantly associated with PVH. CONCLUSIONS: High prevalence of a nondipping status was found in the LI cohort. A nondipping status appears to be directly associated with CIVD independent of PVH. This study indicates the need for further studies to investigate whether or not controlling nighttime BP will help reduce the risk for CI/VD development.     

脑微出血与脑白质病变及腔隙性梗死关系研究

目的 探讨脑微出血（cerebral microbleeds,CMBs）与脑白质病变（white matter lesions,WML）及腔隙性 梗死（lacunar infarcts,LI）的关系。 方法 连续纳入2010年2月至2012年2月解放军总医院南楼神经内科病房根据病史及头颅影像学检 查确诊患有脑血管病或具有高血压、糖尿病、高脂血症等脑血管病危险因素者217例。采用GE公司 1.5T磁共振成像行头颅常规序列及T2 *血管加权成像（T2 star weighted angiography,SWAN）序列扫 描。记录深部及皮层部位CMBs病灶数,按照Fazekas评分和Scheltens改良量表将脑室旁白质高信号 （peri-ventricular hyperintensities,PVH）和深部白质高信号（deep white m atter hyperintensities,DWMH） 分别评分,根据病灶数量评估LI的严重程度分析CMBs与PVH、DWMH及LI的关系。 结果 随着PVH和DWMH评分的升高,CMBs的检出率分别由41.8%（PVH=1）及40.8%（DWMH=1）升高 至68.8%（PVH=3）及76.9%（DWMH=3）;随着LI数量的增加,CMBs的检出率由46.3%升高至75%。深 部CMBs与PVH及DWMH的严重程度有较强相关性（rs =0.345,P＜0.001;rs =0.346,P＜0.001）,与LI 亦显 著相关（r s =0.281,P＜0.001）;而皮层CMBs与PVH及DWMH严重程度仅呈弱相关（r s =0.219,P =0.001; rs =0.189,P =0.005）,与LI无显著相关性。 结论 深部CMBs与脑室旁及深部脑白质病变、LI相关。     

Prevalence and risk factors for cerebral microbleeds in elderly Chinese patients with arteriosclerotic cardiovascular diseases: A single-center study

ObjectivesPeople with arteriosclerotic cardiovascular diseases (ASCVD) frequently use antithrombotic agents and statins. The objective of the study was to explore the prevalence and risk factors of cerebral microbleeds (CMBs) in elderly (≥ 65 years old) Chinese people with ASCVD.Materials and methodsWe prospectively included 755 eligible participants with complete MRI data, and CMBs were discerned on the SWI sequence. Multivariate logistic regression was performed to analyze risk factors associated with CMBs.ResultsThe average age was 74.9 ± 9.5 years, and the prevalence of CMBs was 37.9% (286/755). Of those with CMBs, 65.0% (186/286) had strictly lobar CMBs, 35.0% (100/286) had deep or infratentorial CMBs with or without lobar CMBs. We divided CMBs into two groups according to their locations, lobar CMBs group (strictly lobar CMBs) and deep CMBs group (with or without lobar CMBs). Age per 10 years (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.17–1.72, p < 0.001), statin use (OR 1.54, 95% CI 1.05–2.26, p = 0.03), and lacunes (OR 1.70, 95% CI 1.09–2.68, p = 0.02) were associated with any CMBs. Age per 10 years (OR 1.33, 95% CI 1.10–1.63, p < 0.001), statin use (OR 1.67, 95% CI 1.12–2.50, p = 0.01), and white matter hyperintensities (OR 1.71, 95% CI 1.17–2.51, p < 0.01) were associated with lobar CMBs. Only lacunes were associated with deep CMBs (OR 3.29, 95% CI 1.85–5.87, p < 0.001).ConclusionsIn elderly people with risk factors of ASCVD, antithrombotic drug use was not associated with any CMBs, lobar CMBs, or deep CMBs. Statin use was correlated with lobar CMBs but not deep CMBs.     

Progression of cerebral white matter lesions in Alzheimer's disease: a new window for therapy?

BACKGROUND: White matter lesions (WML) are a risk factor for Alzheimer's disease. Progression of WML is associated with vascular factors and cognitive decline in population based studies but the course of WML is unknown in Alzheimer's disease. OBJECTIVE: To investigate the prevalence and risk factors for progression of WML in Alzheimer's disease. SUBJECTS: 38 patients with Alzheimer's disease for whom blood pressure measurements and sequential brain MRIs were available. METHODS: The proportion of patients with progression of WML was calculated, stratified on baseline absence or presence of WML by analysis of variance. Odds ratios (OR) were calculated by age and sex adjusted logistic regression to quantify the relation between blood pressure and progression of WML. RESULTS: About 25% of the patients showed progression of WML. Patients with WML at baseline had significantly more progression than those without WML at baseline (adjusted mean difference = 1.2; 95% confidence interval (CI), 0.6 to 1.8). Diastolic blood pressure (DBP) was particularly related to progression of WML (OR = 5.9 (95% CI, 1.0 to 37.6) per 10 mm Hg DBP, p = 0.05). CONCLUSIONS: Alzheimer's disease patients with WML at baseline are at risk for rapid progression of WML. WML may offer a potential treatment target in this disease to ameliorate the rate of cognitive decline.     

老年脑白质病变认知功能下降影响因素研究

目的 探讨老年脑白质病变（white matter lesion，WML）患者认知功能下降的影响因素及预测因子。 方法 连续登记2014年9月-2016年9月期间，郑州大学第一附属医院老年病科、神经内科门诊及住 院的无认知功能障碍的WML患者，收集患者人口学资料、血管危险因素及磁共振成像检查结果。入 组时行蒙特利尔认知评估量表（Montreal cognitive assessment scale，MoCA）及脑白质改变分级量表 （age-related white matter changes rating scale，ARWMCRs）评定。根据1年随访时MoCA量表评分分为轻 度认知功能障碍（mild cognitive impairment，MCI）组和无认知障碍组。通过单因素和多因素Logistic回 归分析，判断老年WML患者认知功能下降的影响因素及预测因子。 结果 研究共入组118例WML患者，其中男性67例，女性51例，平均年龄（68.07±3.70）岁。1年随访时 有100例（84.75％）患者保持原有认知状态不变，18例（15.25％）进展为MCI。Logistic回归分析发现高 血压病[比值比（odds ratio，OR）1.47，95%可信区间（confidence interval，CI）1.08～1.93，P =0.013）]和 糖尿病（OR 1.38，95%CI 1.01～1.88，P =0.042）是WML患者进展为MCI的独立危险因素，ARWMCRs评分 ≥8分（OR 1.84，95%CI 1.38～2.47，P =0.004）是WML患者进展为MCI的独立预测因子。 结论 高血压病和糖尿病是WML患者进展为MCI的独立危险因素，ARWMCRs评分≥8分是WML患者进 展为MCI的独立预测因子。     

无基础代谢性疾病急性缺血性卒中患者短期营养不良预测模型构建与验证

目的 分析无基础代谢性疾病急性缺血性卒中（acute ischemic stroke,AIS）患者短期营养不良的影响因素,并构建AIS短期营养不良的临床预测模型。方法 回顾性选取2019年3月—2021年6月在苏州市第九人民医院神经内科治疗的无基础代谢性疾病AIS患者作为建模队列,以患者入院2周时微型营养评定简表（mini-nutritional assessment short-form,MNA-SF）、BMI和白蛋白（albumin,Alb）指标作为综合评估,即MNA-SF评分＜8分且BMI＜18.5 kg/m2、Alb＜35.0 g/L为营养不良,以此为依据划分营养不良组和无营养不良组。比较两组的人口学特征及入院时临床资料,将单因素分析具有统计学意义的变量纳入多因素logistic回归分析,基于多因素分析出的影响指标构建预测模型。用ROC曲线评价其区分度,用拟合优度检验评价其校准度。以2021年8月—2022年6月在苏州市第九人民医院神经内科治疗的无基础代谢性疾病AIS患者作为验证队列验证模型的效能。 结果 建模队列共纳入924例无基础代谢性疾病AIS患者,平均（55.0±14.3）岁,男性544例（58.9%）。入院2周时的营养评估发现72例（7.8%）营养不良。多因素分析显示,高龄（OR 2.059,95%CI 1.132～3.743,P=0.018）、饮酒史（OR 1.747,95%CI 1.076～2.835,P=0.024）、入院时有营养风险（OR 2.951,95%CI 1.485～5.859,P=0.002）、院内无营养支持（OR 1.870,95%CI 1.065～3.284,P=0.029）、入院才藤氏分级低（OR 0.226,95%CI 0.079～0.652,P=0.006）、入院NIHSS评分高（OR 1.556,95%CI 1.057～2.289,P=0.025）均为无基础代谢性疾病AIS患者短期营养不良的独立影响因素。根据影响因素得出预测模型方程：logit（P）=0.722×年龄+0.558×饮酒史+1.082×入院时营养风险+0.626×院内无营养支持-1.483×才藤氏分级+0.442×NIHSS评分+0.479-31.187。该模型预测患者短期营养不良的AUC为0.863（95%CI 0.811～0.914）,最大约登指数（0.703）对应的灵敏度和特异度分别为87.50%、83.90%;拟合优度检验χ2=2.754,P=0.498。验证队列共纳入126例无基础代谢性疾病AIS患者,采用模型对其营养不良进行预测得出的灵敏度为86.96%、特异度为83.50%、准确率为84.13%。结论 高龄、饮酒史、入院时有营养风险、院内无营养支持、才藤氏分级低和入院NIHSS评分高是无基础代谢性疾病AIS患者短期营养不良的影响因素,经验证基于上述指标构建临床预测模型具有良好的预测效能。