病灶部位与缺血性脑卒中幸存者生命质量变化趋势关系的研究

Lesion Locations and Quality of Life in Patients with Ischemic Stroke

目的探讨缺血性脑卒中幸存者病灶部位与生命质量变化趋势的关系。方法采用欧洲五维健康量表(EQ-5D)定期观测456例初发缺血性脑卒中幸存者2年期间的生命质量。采用CT、MRI结合临床特征确定病灶部位;并采用多水平模型分析病灶部位与生命质量变化趋势的关系。结果研究对象中约3/5幸存者为前循环缺血(ACI)病灶,ACI中约1/2幸存者的病灶位于皮质下;左、右半球病变者的比例为1∶1。多水平模型分析结果提示病灶据大脑侧别分类,仅右侧大脑半球病变者与非大脑病变者生命质量的变化趋势不一致(P<0.001);而根据受累的脑血管系统及脑部解剖结构分类,提示前循环皮质及以下均有病变者与同类别其他组间生命质量的变化趋势均不一致(P<0.044)。结论病灶部位对脑卒中幸存者生命质量的变化趋势有影响。建议今后研究者尝试根据受累的脑血管系统和脑部解剖结构对病灶进行更详细的分类,并结合病灶大小,进一步探索病灶部位与生命质量的关系。

Objective To determine the relationship between lesion locations and quality of life（QOL）in patients with ischemic stroke.Methods The QOL of 456 stroke survivors was assessed two years after the occurrence of stroke.The EQ-5Dwas used for measuring QOL.Lesion locations of the patients were identified with CT,MRI and clinical features.Risk factors associated with QOL were identified using a multi-level model.Results Among the 456 stroke survivors,61.62%（3/5）had ACI lesions,and more than half of ACI occurred in the subcortex.The number of stroke survivors with left and right hemisphere lesions was almost equal.Different QOL was found between stroke survivors with a right-side brain lesion and those with non-brain lesions（P〈0.001）.Significant differences in QOL were also found between those with a subcortex of anterior circulation lesion and others（P〈0.044）.Conclusion Lesion locations are associated with QOL.Future studies should pay attention to lesion locations classified by vascular territory and brain anatomical structures and size of lesions.