脑小血管病影像总负荷与急性脑梗死静脉溶栓远期预后的相关性研究

目的研究CSVD影像学总负荷与急性脑梗死静脉溶栓远期预后的相关性。方法回顾性连续收集我院2018年1月-2020年1月收治的发病4.5 h之内经重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓的急性脑梗死患者124例,收集患者的一般基线资料,发病48 h之内行头颅MRI检查,根据Staals等的评分标准,评估患者CSVD影像学总负荷评分为0~4分,通过电话随访评估患者90 d mRS评分,根据mRS评分将患者分为预后良好组(mRS:0~2分)和预后不良组(mRS:3~5分),比较2组患者的一般资料及影像学CSVD评分有无差异。结果124例脑梗死静脉溶栓患者远期预后基线资料的单因素分析发现预后良好患者82例(66%),预后不良患者42例(34%),静脉溶栓早期有出血转化患者10例,其中HI-1型8例,PH-1型2例,2组出血转化差异无统计学意义(P>0.05),无死亡患者。2组患者基线资料比较显示溶栓前NIHSS评分、溶栓前舒张压水平、高密度脂蛋白胆固醇水平、既往房颤病史、既往心衰病史、既往脑梗死病史、TOSTA分型、CSVD影像总负荷两组间差异有统计学意义(P<0.05)。其余资料比较两组间差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示溶栓前NIHSS评分(OR=1.241,95%CI 1.125~1.370,P<0.001)、高CSVD总评分(OR=2.393,95%CI 1.493~3.873,P<0.001)是影响脑梗死静脉溶栓预后的独立危险因素;CSVD不同影像表现中WMH中重度(OR=2.560,95%CI 1.158~5.662,P<0.020)和腔隙性脑梗死(OR=5.030,95%CI 1.579~16.044,P<0.006)是预后的独立危险因素。结论急性脑梗死静脉溶栓患者CSVD影像总负荷评分较高者与90 d不良预后相关,影像学表现为腔隙性脑梗死及中重度的WMH是不良预后的独立危险因素。

Study on the relationship between the total image burden of cerebral small vessel disease and the long-term prognosis of acute stroke patient after intravenous thrombolysis

Objective To study the correlation between the total image burden of cerebral small vessel disease and the long-term prognosis of acute stroke patients after intravenous thrombolysis.Methods 124 patients with acute stroke who received intravenous thrombolysis with recombinant tissue plasminogen activator(rt-PA)within 4.5 hours from January 2018 to January 2020 in our hospital were collected retrospectively.The general baseline data of the patients were collected,and the head MRI was performed within 48 hours after the onset of the disease.According to the scoring standards of staals,the total CSVD imaging burden score of the patients was divided into 0~4.The patients were divided into a good prognosis group(mRS:0~2 points)and a bad prognosis group(mRS:3~5 points)according to the mRS score followed by telephone.The difference in the general data and the CSVD cores of the two groups was compared.Results The single factor analysis of the baseline data of 124 patients with cerebral stroke showed that 82 patients(66%)had a good prognosis,42 patients(34%)had a poor prognosis,and ten patients(8 of HI-1,2 of PH-1)had a bleeding transformation in the early stage of thrombolysis.There was no significant difference in the bleeding transformation between the two groups(P>0.05).The baseline data of the two groups showed that there were significant differences in NIHSS score,diastolic blood pressure before thrombolysis,high-density lipoprotein cholesterol level,history of atrial fibrillation,history of heart failure,history of cerebral infarction,TOSTA classification and total image burden score of CSVD between the two groups(P<0.05).There was no significant difference in other data between the two groups(P>0.05).Multivariate logistic regression analysis showed that NIHSS score(OR=1.241,95%CI 1.125~1.370,P<0.001)and higher total burden score of CSVD(OR=2.393,95%CI 1.493~3.873,P<0.001)were independent risk factors for the prognosis of cerebral stroke intravenous thrombolysis;WMH moderate and severe(OR=2.560,95%CI 1.158~5.662,P<0.020)and lacunar cerebral infarction(OR=5.030,95%CI 1.579~16.044,P<0.006)were independent risk factors for prognosis.Conclusion The high score of CSVD in patients with acute stroke after intravenous thrombolysis,is related to the poor prognosis in 90 days.The imaging manifestations of lacunar infarction and moderate or severe WMH are independent risk factors for the poor prognosis.