扩大的血管周围间隙与急性缺血性脑卒中患者神经功能恢复及生活质量的相关性研究

目的 探讨扩大的血管周围间隙与急性缺血性脑卒中患者神经功能预后及生活质量的相关性。方法 收集2014年1月-2016年4月南方医科大学附属南海医院神经内科住院的急性缺血性脑卒中患者842例,记录其年龄、性别、美国国立卫生研究院卒中量表(NIHSS)评分等基线资料; 根据颅脑磁共振(MRI)表现分为有扩大的血管周围间隙组(EPVS)及无扩大的血管周围间隙组; 在发病1年通过门诊随访,采用改良Rankin量表(modified Rakin Scale, mRS)对患者的神经功能缺损情况进行评价,使用欧洲五维健康量表(EQ-5D)评估了生活质量,包括机动性、自我保健、日常活动、疼痛或不适、焦虑或抑郁等,然后将患者分为功能预后良好(mRS≤2分)及不良组(mRS>2分),生活质量低劣的定义为EQ-5D指标得分0.5或更低,将纳入因素进行单因素分析及多因素Logistis回归分析。结果 共纳入842例急性脑梗死患者,其中58例患者失访,共纳入784例。有扩大的血管周围间隙组有218(57.9%)例发生了不良的神经功能预后,而无扩大的血管周围间隙组有198(48.5%)例(P=0.008)。有扩大的血管周围间隙组146例(38.8%)和无扩大的血管周围间隙组92例(22.5%)患者生活质量较差(P=0.000)。EPVS是急性缺血性脑卒中患者功能恢复不良(OR=1.232,95%CI=1.009～1.505),生活质量低下(OR=1.421,95%CI=1.093～1.847)的独立预测因子。亚组分析显示EPVS评分2～4级组与EPVS评分0～1级组比较,功能恢复不良(P=0.003)及生活质量低下(P=0.001)的差异明显。结论 扩大的血管周围间隙是急性缺血性脑卒中患者神经功能预后及生活质量低下的预测因子。

Correlation study between enlarged perivascular spaces and outcomes in patients with acute cerebral infarction

ObjectiveTo investigate the correlation between enlarged perivascular spaces and outcomes, including functional outcome and quality of life, in patients with acute cerebral infraction.Methods The clinical data of 784 patients with acute ischemic stroke were collected. Based on the Magnetic resonance imagine(MRI)manifestation, the patients were divided into two groups:with EPVS group and without EPVS group. The baseline data were recorded. Participants were assessed at 1 year for functional outcome using the modified Ran-kin Scale(mRS)and quality of life using the EuroQol-5 Dimension(EQ-5D). Poor functional outcome was defined as mRS score of 3～6 score at 1 year and poor quality of life was defined as EQ-5D index score of 0.5 or less.Results Poor functional outcome occurred in 218 patients(57.9%)in the EPVS group, compared with 198(48.5%)in the without EPVS group(P=0.008). Poor quality of life occurred in 146(38.8%)in the EPVS group and in 92(22.5%)in the without EPVS group(P=0.000).EPVS was a independent prognostic factor for long term poor functional outcome(OR=1.232,95%CI =1.009～1.505)and long term poor quality of life(OR=1.421,95%CI =1.093～1.847). In the subgroup analysis of EPVS, there was difference in 1 year functional outcome(P=0.003)and quality of life(P=0.001)between the 2 groups.Conclusion EPVS was a prognostic factor for poor functional outcome and poor quality of life in patients with acute cerebral infraction.