脑白质疏松对急性脑梗死患者转归及并发症的影响

The effect of leukoaraiosis on the outcome and complications of acute cerebral infarction

目的探讨脑白质疏松对急性脑梗死患者转归及并发症的影响。方法对诊断为急性脑梗死的323例连续病例行MRI检查,并将其脑白质高信号(WMH)严重程度分级,在患者入院时、7d、14d及出院时进行NIHSS评分,对不同级别脑白质损害与脑梗死患者急性期的神经功能恢复情况、并发症、出院时日常生活能力情况间联系进行统计学分析。结果本组患者WMH0级33例,1级107例,2级118例,3级65例。严重的脑白质疏松患者神经功能水平恢复较差,出院时不能自理比例更高,脑白质疏松患者在急性梗死后更容易发生肺部感染和泌尿系统感染。脑白质疏松和上呼吸道感染、脑梗死出血转化、急性胃黏膜病变以及肠道功能紊乱无明确联系。结论脑白质疏松和急性脑梗死患者的转归有密切联系,脑白质疏松患者在急性梗死后更容易发生肺部感染和泌尿系统感染可能是其机制之一。

Objective To determine the effect of leukoaraiosis on the outcome and complications of acute cerebral infarction patients. Methods MRI was performed in 323 consecutive patients with acute cerebral infarction, inclu- ding T1 - weighted, T2 - weighted, fluid attenuated inversion recovery （ FLAIR ） and diffusion - weighted imaging （DWI） sequences. Leukoaraiosis was graded as 0 （absent）, 1 （mild）, 2 （medium）, 3 （ severe ） with Fazekas ＇ scale. The relationships between the severity of leukoaraiosis and the neurological function recovery, complications and daily living function were explored. Results Compared with those who had low grade leukoaraiosis, patients with severe leukoaraiosis had worse neurological function recovery, higher rate of independence, longer time and higher expense of hospi- talization. Furthermore, pneumonia and infection of urinary system were more prevalent in acute cerebral infarction patients who had more severe leukoaralosis. No significant relation between acute upper respiratory infection, hemorrhagic transformation of cerebral infarcts, acute gastric mucosal lesions, diarrhea and leukoaraiosis was found. Condusions Leukoaraiosis has close association with the outcomes of patients with acute cerebral infarction. The susceptibility to pneumonia and infection of urlnarv svstem may contribute to such an association.