中重度脑白质疏松与急性脑梗死患者出血转化和预后关系的随访研究

目的探讨中重度脑白质疏松(leukoaraiosis,LA)对急性脑梗死患者出血转化和预后的影响。方法选取2015年6月至2018年5月浙江中医药大学附属第二医院神经内科收治的287例急性前循环脑梗死患者为研究对象,随访90 d。采用CT检查判断是否颅内出血,90 d mRS评价患者预后。依据Fazekas量表分为LA组和无LA组,比较两组患者的临床特征,并用Logistic回归分析LA对急性脑梗死患者出血转化和预后的影响。结果急性前循环脑梗死合并LA者91例(31.7%),出血转化发生率为20.9%(19/91),预后不良为46.2%(42/91);无LA的急性前循环脑梗死者196例(68.3%),出血转化发生率为11.7%(23/196),预后不良为20.4%(40/196)。出血转化危险因素Logistic回归分析显示:中重度LA是急性前循环脑梗死患者出血转化的独立危险因素(回归系数=0.765,标准误=0.275,Wald值=7.739,OR=2.149,95%CI:1.254~3.684,P=0.012)。90 d预后危险因素Logistic回归分析显示:中重度LA是急性前循环脑梗死患者预后不良的独立危险因素(回归系数=0.848,标准误=0.357,Wald值=5.642,OR=2.335,95%CI:1.160~4.701,P=0.031)。结论合并中重度LA的急性前循环脑梗死患者发生出血转化的比例高,90 d预后差,且中重度LA是急性前循环脑梗死出血转化和预后不良的独立危险因素。

A follow-up study on the relationship between moderate to severe leukoaraiosis and hemorrhagic transformation and prognosis of patients with acute ischemic stroke

Objective To investigate the effect of moderate to severe leukoaraiosis on hemorrhagic transformation and prognosis in patients with acute cerebral infarction.Methods Totally 287 patients with acute anterior circulation cerebral infarction admitted to Neurology Department,the Second Affilitated Hospital of Zhejiang Chinese Medical University from June 2015 to May 2018 were selected as the study subjects and followed up for 90 days. Intracranial hemorrhage was detected by CT and prognosis was evaluated by 90-day mRS. According to Fazekas scale,the patients were divided into LA group and non-LA group. The clinical characteristics of the two groups were compared,and the effect of LA on hemorrhage transformation and prognosis of patients with acute cerebral infarction was analyzed by Logistic regression. Results Totally91 cases(31%) of acute anterior circulation cerebral infarction complicated with LA,the incidence of hemorrhagic transformation was 20.9%(19/91),and the poor prognosis was 46.2%(42/91);196 cases(68.3%)of acute anterior circulation cerebral infarction were without LA,the incidence of hemorrhagic transformation was 11.7%(23/196),and the poor prognosis was 20.4%(40/196). Logistic regression analysis showed that moderate to severe LA was an independent risk factor for hemorrhagic transformation in patients with acute anterior circulation cerebral infarction(regression coefficient=0.765,standard error=0.275,Wald value=7.739,OR=2.149,95% CI=1.254-3.684,P=0.012). Logistic regression analysis of90-day prognostic risk factors showed that moderate to severe LA was an independent risk factor for poor prognosis in patients with acute anterior circulation cerebral infarction(regression coefficient=0.848,standard error=0.357,Wald value=5.642,OR=2.335,95% CI =1.160-4.701,P=0.031). Conclusion The incidence of hemorrhagic transformation in patients with acute anterior circulation cerebral infarction combined with moderate to severe LA is high and the 90-day prognosis is poor,and moderate to severe LA is an independent risk factor for hemorrhagic transformation and poor prognosis in patients with acute anterior circulation cerebral infarction.