合并小血管病的颅内大动脉狭窄患者的预后

Coexisting small vessel disease predicts long-term outcome in stroke patients with intracranial large artery atherosclerosis

目的探讨合并的小血管病(SVD)对颅内大血管动脉粥样硬化(ILAA)性卒中患者的远期预后影响。方法前瞻性随访293例症状性ILAA患者,将之分为4组(组1为单个ILAA不伴SVD;组2为多个ILAA不伴SVD;组3为单个ILAA伴SVD;组4为多个ILAA伴SVD),观察随访期的卒中复发率和死亡率。结果 4组患者3年的累积卒中复发风险分别为18%、38%、21%和34%;3年累积死亡风险分别6%、7%、21%和22%。与组1相比,组2和组4的卒中复发率显著增高(P分别为0.05和0.014),组4的死亡率显著增高(P=0.002)。Cox回归分析提示伴SVD是多发ILAA患者卒中复发和死亡的预示因子。结论 SVD常与ILAA合并且与不良预后相关。

Objective To evaluate the long-term outcome of coexisting small vessel disease(SVD)in stroke patients with intracranial large artery atherosclerosis(ILAA).Methods A prospective study was performed on 293 patients with symptomatic ILAA,which were divided into 4 groups(group 1:single intracranial large artery atherosclerosis(SILAA)without SVD;group 2,multiple intracranial large arteries atherosclerosis(MILAA)without SVD;group 3,SIALL with SVD;group 4,MILAA with SVD)and observed recurrence rate and death rate during followed-up period.Results The 3-year cumulative risks of recurrent stroke for group 1~4 were 18%,38%,21% and 34%,respectively.The 3-year cumulative risks of death were 6%,7%,20% and 22%,respectively.Compared with group 1,more recurrent stroke was occurred in group 2(P=0.050)and group 4(P=0.014),and the higher risk of death(P=0.002)was found in group 4.A Cox regression model showed that group 4 may be a predictor of recurrent stroke and death.Conclusion Coexisting SVD is very common and may predict poor outcome in stroke patients with ILAA.