脑小血管病总负荷评分与静脉溶栓治疗急性缺血性卒中患者1年预后相关性研究

目的探讨脑小血管病(cerebral small vessel disease,CSVD)总负荷评分与急性缺血性卒中(acute ischemic stroke,AIS)患者静脉溶栓后1年预后的关系。方法前瞻性连续纳入2017年1月-2018年12月于深圳市人民医院神经内科住院并接受rt-PA静脉溶栓治疗的AIS患者,根据MRI评估CSVD负荷并计算CSVD总负荷评分。使用mRS量表评估患者发病1年的神经功能预后,利用多因素Logistic回归分析确定CSVD的总负荷与1年的神经功能预后之间的关系,利用ROC曲线分析CSVD总负荷评分对不良预后的预测价值及最佳界值。结果最终入组135例静脉溶栓的AIS患者,平均年龄为61.56±12.64岁,CVSD总负荷评分0分者17例(12.59%),1分者44例(32.59%),2分者38例(28.15%),3分者30例(22.22%),4分者6例(4.44%)。多因素分析发现溶栓前NIHSS评分(OR 1.615,95%CI 1.209~2.157,P=0.001)、CSVD总负荷评分(OR 1.570,95%CI 1.095~4.094,P=0.026)为AIS静脉溶栓患者1年功能预后的独立影响因素。CSVD总负荷预测静脉溶栓后1年不良预后的ROC曲线下面积(area under the ROC curve,AUC)为0.735(95%CI 0.641~0.828),最佳界值为2.5分;溶栓前NIHSS评分的AUC为0.773(95%CI 0.684~0.862),最佳界值为6.5分。结论CSVD总负荷评分及溶栓前NIHSS评分为AIS患者静脉溶栓治疗1年功能预后不良的可靠预测指标,有助于临床评估静脉溶栓患者长期预后。

Correlation between Total Cerebral Small Vessel Diseases Burden and Long-term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Objective To explore the relationship between the total cerebral small vessel diseases (CSVD)
burden and 1-year outcome after intravenous thrombolysis in patients with acute ischemic stroke.
Methods This prospective study consecutively enrolled patients with acute ischemic stroke who
received intravenous recombinant tissue plasminogen activator (rt-PA) and underwent MRI between
January 2017 and December 2018. The total burden score of CSVD was calculated according to
MRI results. 1-year outcome after stroke was evaluated using the modified Rankin scale (mRS).
Multivariate logistic regression analysis was used to identify the relationship between the total
burden score of CSVD and 1-year poor prognosis. ROC curve analysis was used to determine the
area under the curve (AUC) and optimal cut-off value of the total CSVD score for predicting 1-year
poor outcome.
Results A total of 135 patients were included, with an average age of 61.56±12.64 years old. Therewere 17 cases (12.59%) with a total CSVD score of 0, 44 cases (32.59%) with a score of 1, 38 cases
(28.15%) with a score of 2, 30 cases (22.22%) with a score of 3, and 6 cases (4.44%) with a score of 4.
Multivariate analysis showed that NIHSS at admission (OR 1.615, 95%CI 1.209-2.157, P =0.001) and
total CSVD score (OR 1.570, 95%CI 1.095-4.094, P =0.026) were independent risk factors for 1-year
outcome. The AUC and optimal cut-off value of total CVSD score and NIHSS score at admission for
predicting 1-year poor outcome were 0.735 (95%CI 0.641-0.828) and 2.5, 0.773 (95%CI 0.684-0.862)
and 6.5, respectively.
Conclusions The total CSVD burden score and NIHSS score at admission were independent
influencing factors for 1-year outcome after intravenous thrombolysis in acute ischemic stroke.