缺血性小卒中患者1年卒中复发的相关因素分析——来自中国颅内动脉粥样硬化研究的数据

目的通过分析急性期缺血性小卒中患者磁共振成像(magnetic resonance imaging,MRI)弥散加权成像(diffusion weighted imaging,DWI)的病灶模式及磁共振血管成像(magnetic resonance angiography,MRA)/增强磁共振血管成像(contrast enhanced magnetic resonance angiography,CE-MRA)反映的大血管病变情况,结合临床信息,探讨对小卒中1年卒中复发有较强预测作用的评价指标。方法以中国颅内动脉粥样硬化研究(Chinese Intra Cranial Atherosclerosis Study,CICAS)数据库中的患者资料为数据来源,纳入发病7 d内、病前改良Rankin量表(modified Rankin Scale,m RS)评分≤2分、脑部MRI-DWI发现新梗死病灶、入院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分4分的缺血性卒中患者;收集患者的基线信息和影像信息所示不同病变模式及大血管病变情况,以单变量分析和多变量分析确定小卒中后1年卒中复发的预测因素。结果本研究最终纳入843例缺血性小卒中患者,平均年龄(61.67±11.04)岁。1年累计卒中复发率4.39%。1年预后的Cox回归分析结果显示:年龄75岁[风险比(hazard ratio,HR)3.18,95%可信区间(confidence interval,CI)1.140~7.211,P=0.006)],症状相关性动脉闭塞(HR 2.35,95%CI 1.094~5.030,P=0.029),多发非症状相关性动脉狭窄(HR 2.74,95%CI 1.311~5.730,P=0.007),多发皮层、皮层下和(或)深部白质梗死(HR 2.06,95%CI 1.006~4.229,P=0.048)是1年卒中复发的独立预测因子。结论急性缺血性小卒中患者影像学检查对于判断预后有重要意义,DWI所示多发皮层、皮层下和(或)深部白质病变、多发颅内外动脉狭窄是小卒中1年卒中复发的独立预测因子。

Study on the Factors of the Recurrent Stroke in Patients with Minor Ischemic Stroke at 1 Year--from the Chinese Intracranial Atherosclerosis Study (CICAS)

Objective To evaluate various brain magnetic resonance imaging diffusion weighted imaging(MRI-DWI) lesion patterns and the severity of large vessel stenosis assessed in the acute phase ofminor ischemic stroke to figure out the predictors for recurrent stroke at 1 year.Methods We studied patients presenting with minor ischemic stroke in the Chinese IntracranialAtherosclerosis Study (CICAS)-group. The inclusion criteria of our study have included that within7 days of stroke onset, the modified Rankin Scale (mRS) score was 2 before enrollment, minorischemic stroke (National Institutes of Health Stroke Scale [NIHSS]<4), the complete baseline andfollow-up data and acute MRI-DWI lesions. Baseline characteristics, treatment, different MRI-DWIlesion patterns and the severity of large vessel stenosis were collected. Predictors of recurrent stroke,combined cardiac and cerebrovascular events, poor outcome at 1 year were analyzed by univariateand multivariate analysis.Results A total of 843 patients, mean age of (61.67±11.04) years, were included in the study. Theincidence of cumulative stroke recurrence rate at 1 year were 4.39%. Multivariate analysis showedthat age>75 years ([hazard ratio] HR 3.18, 95% [confidence interval] CI 1.140~7.211, P =0.006),symptomatic artery occlusion ( HR 2.35, 95% CI 1.094~5.030, P =0.029), multiple asymptomaticartery stenosis ( HR 2.74, 95% CI 1.311~5.730, P =0.007), multiple cortical, subcortical and deepwhite matter DWI lesions ( HR 2.06, 95% CI 1.006~4.229, P =0.048) were significant predictors forrecurrent stroke at 1 year.Conclusion Imaging is a useful judgment implement for the outcome of patients with minorischemic stroke. Multiple cortical, subcortical or deep white matter lesions, multiple intracranialand extracraninal arterial stenosis are significant predictors for recurrent stroke at 1 year.