脑小血管病负荷预测轻型急性脑梗死静脉溶栓后不良预后

目的探讨脑小血管病(CSVD)负荷与轻型急性脑梗死(ACI)静脉溶栓后3月不良预后的关系。方法回顾性分析2016~2019年在东莞市人民医院神经内科接受重组组织纤溶酶原激活剂静脉溶栓的161例轻型ACI患者的资料。研究的临床变量包括年龄、性别、血管危险因素、美国国立卫生研究院卒中评分(NIHSS)及血液学和MR参数。轻型ACI定义为基线NIHSS≤7分,3月不良预后定义为改良Rankin评分≥3分。CSVD负荷包括脑白质高信号(WMHs)、腔隙性脑梗死、脑微出血(CMBs)和扩大的周围血管间隙。根据头颅MR影像评价CSVD总体负荷,根据Fazekas分级量表评估WMHs严重程度。结果161例患者中男性117例(72.7%),3月不良预后患者为29例(18.0%)。单因素分析显示,基线NIHSS、房颤、症状性颅内动脉狭窄、WMHs和CMBs与急性轻型ACI静脉溶栓后3月不良预后有关(P<0.05)。分别将WMHs及CMBs进入两个Logistic回归方程模型。模型1中,基线NIHSS(OR=1.601,95%CI:1.203~2.130,P=0.001)、症状性颅内动脉狭窄(OR=2.658,95%CI:1.013~6.978,P=0.047)和WMHs(OR=1.449,95%CI:1.033~2.031,P=0.032)与轻型ACI静脉溶栓后3月不良预后显著相关;模型2中,基线NIHSS(OR=1.650,95%CI:1.232~2.210,P=0.001),症状性颅内动脉狭窄(OR=3.732,95%CI=1.435~9.702,P=0.007)和CMBs(OR=1.242,95%CI:1.062~1.452,P=0.007)与轻型ACI静脉溶栓后3月不良预后显著相关。结论WMHs和CMBs是轻型ACI静脉溶栓后3月不良预后的预测因子。

Cerebral small vessel disease load predicts poor prognosis in mild acute cerebral infarction after intravenous thrombolysis

  Objective  To investigate the relationship between cerebral small vessel disease (CSVD) load and 3-month poor prognosis in mild acute cerebral infarction (ACI) treated with recombinant tissue plasminogen activator.  Methods  161 patients with mild ACI who received intravenous thrombolysis with recombinant tissue plasminogen activator from 2016 to 2019 were retrospectively analyzed. Clinical variables studied included age, gender, vascular risk factors, National Institute of Health Stroke Score (NIHSS) as well as initial hematologic and MR parameters. Mild acute cerebral infarction was defined as a baseline NIHSS score ≤7 and a 3-month poor prognosis was defined as a modified Rankin score ≥3. CSVD load included white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs) and enlarged perivascular space. Total CSVD load was evaluated based on the clinical MR images, and severity WMHs was assessed according to the Fazekas criteria.  Results  Of the 161 patients, 117 (72.7%) were male, and the number of patients with a poor 3-month prognosis was 29 (18.0%). Univariate analysis showed that baseline NIHSS, atrial fibrillation, symptomatic intracranial artery stenosis (SIAS), WMHs and CMBs were correlated with 3-month poor prognosis (P < 0.05). WMHs and CMBs were entered into two logistic regression equation models, respectively. In Model 1, baseline NIHSS (OR=1.601, 95% CI: 1.203-2.130, P=0.001), symptomatic intracranial artery stenosis (OR=2.658, 95% CI: 1.013-6.978, P=0.047) and WMHs (OR=1.449, 95% CI: 1.033-2.031, P=0.032) were significantly associated with 3-month poor prognosis. In Model 2, baseline NIHSS (OR=1.650, 95% CI: 1.232- 2.210, P=0.001), symptomatic intracranial artery stenosis (OR=3.732, 95% CI: 1.435-9.702, P=0.007) and CMBs (OR=1.242, 95% CI: 1.062-1.452, P=0.007) were significantly correlated with poor prognosis at 3 months after intravenous thrombolysis for mild ACI.  Conclusion   WMHs and CMBs are predictors of poor prognosis at 3 months after intravenous thrombolysis in mild ACI.