症状性颅内动脉粥样硬化性狭窄的预后分析

Prognosis Analyses with Symptomatic Intracranial Atherosclerotic Stenosis in Patients with Ischemic Stroke

目的探讨唐山地区急性缺血性卒中住院患者的症状性颅内动脉粥样硬化性狭窄（symptomatic intracranial atherosclerotic stenosis,s ICAS）的发生率和6个月预后情况。方法前瞻性、连续登记唐山工人医院缺血性卒中和短暂性脑缺血发作（transient ischemic attack,TIA）的住院患者231例,均经头及颈部计算机断层扫描血管成像（computed tomography angiography,CTA）检查评估颅内外大血管,按血管病变分布情况,分为s ICAS组、非s ICAS组,并对s ICAS组进行6个月随访,按结局分为预后良好组和预后不良组,应用单因素和多因素Logistic回归方程分析s ICAS患者6个月预后的影响因素。结果本研究共纳入急性缺血性卒中患者231例,其中有108例（包括单纯颅内动脉病变95例和颅内外联合病变组13例）存在s ICAS,s ICAS发生率为46.8%。单因素分析显示s ICAS患者6个月良好预后与入院美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分[比值比（odds ratio,OR）0.872,95%可信区间（confidence interval,CI）0.775-0.980,P=0.022]、高同型半胱氨酸血症（OR 0.354,95%CI 0.132-0.984,P=0.039）、抗凝治疗（OR 2.597,95%CI 1.123-6.004,P=0.026）有关;多因素分析显示：与轻度狭窄患者相比,血管重度狭窄（OR 0.182,95%CI 0.035-0.943,P=0.042）和闭塞（OR 0.156,95%CI 0.029-0.833,P=0.021）患者、入院NIHSS评分更高（OR 0.768,95%CI 0.661-0.892,P=0.001）患者以及伴有高同型半胱氨酸血症（OR 0.177,95%CI 0.051-0.608,P=0.006）患者6个月预后更差;给予抗凝治疗（OR 7.714,95%CI 2.440-24.389,P=0.001）患者6个月预后更好。结论唐山地区急性缺血性卒中住院患者中接近半数存在s ICAS。入院NIHSS评分更高、血管重度狭窄和闭塞、伴有高同型半胱氨酸血症的s ICAS患者6个月预后更差,而抗凝治疗能够改善s ICAS患者的6个月神经功能残障。

Objective To investigate the prevalence and prognosis of symptomatic intracranial atherosclerotic stenoses（s ICAS） among patients with ischemic stroke in Tangshan.Methods Two hundred and thirty-one patients were included prospectively and consecutively with acute cerebral infarction or transient ischemic attack（TIA）, who underwent computed tomography angiography（CTA）. According to the distribution of the different vascular lesions, all of patients were divided into two groups： the s ICAS and the non-s ICAS. Univariate and multivariate Logistic regression were used to analyze the infl uence factors of the prognosis in patients with s ICAS.Results In this study, we found that the prevalence of s ICAS in in-patients with ischemic stroke was 46.8%（108/231）. Univariate analyses showed that the National Institutes of Health Stroke Scale（NIHSS） scores at admission（odds ratio [OR] 0.872, 95%conf idence interval [CI] 0.775-0.980, P =0.022）, hyperhomocysteinemia（OR 0.354, 95%CI 0.132-0.984, P =0.039） and anticoagulationtherapy（OR 2.597, 95%CI 1.123-6.004, P =0.026） were associated with the favorable outcomes of sI CAS patients at 6 months. Multivariate Logistic regression analyses demonstrated that the patients with severe arterial stenoses（OR 0.182, 95%CI 0.035-0.943, P =0.042） and occlusions（OR 0.156, 95%CI 0.029-0.833, P =0.021） had more poor outcomes than those with mild arterial stenoses, and the patients with high baseline NIHSS scores（OR 0.768, 95%CI 0.661-0.892, P =0.001） and hyperhomocysteinemia（OR 0.177, 95%CI 0.051-0.608, P =0.006） had worse prognoses, however, the patients receiving anticoagulative drug treatment（OR 7.714, 95%CI 2.440-24.389, P =0.001） had better outcomes at 6 months.Conclusion Nearly half of the in-patients with acute ischemic stroke have s ICAS in Tangshan. High NIHSS scores at admission, arterial severe stenoses/occlusions, hyperhomocysteinemia are the predictors of unfavorable outcomes, whereas anticoagulation therapy is associated with favorable outcomes.