脑微出血与急性缺血性卒中患者早期神经功能恶化的相关性

Correlation between cerebral microbleeds and early neurological deterioration in patients with acute ischemic stroke

目的 探讨脑微出血（cerebral microbleeds,CMBs）与急性缺血性卒中患者早期神经功能恶化（early neurological deterioration,END）的相关性.方法 前瞻性纳入连续急性缺血性卒中患者,收集临床资料、影像学资料和实验室检查资料.END定义为7 d内美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分较基线增加≥2分.采用磁敏感加权成像检测CMBs.采用多变量logistic回归分析确定CMBs与END的独立相关性.结果 共纳入246例急性缺血性卒中患者,END发生率为38.21％（94/246）,78.72％（74/94）发生于72 h内,21.28％（20/94）发生于72 h～7 d.END组CMBs检出率为72.34％（68/94）,非END组CMBs检出率为43.42％（66/152）,两组之间存在显著统计学差异（χ2=19.587,P〈0.001）.多变量logistic回归分析显示,既往卒中或短暂性脑缺血发作史[优势比（odds ratio,OR）1.883,95％ 可信区间（confidence interval,CI）1.284～2.277;P=0.033）、大动脉粥样硬化（OR 4.119,95％CI 2.564～5.771;P=0.003）、基线NIHSS评分（OR 1.682,95％CI 1.320～1.876;P=0.042）、重度卒中（OR 4.228,95％CI 2.634～5.917;P=0.003）、发病至入院时间（OR 2.070,95％CI 1.454～2.582;P=0.029）、CMBs数量≥10个（OR 2.728,95％CI 1.834～3.217;P=0.016）是END的独立危险因素.结论 急性缺血性卒中患者中END较为常见,多数发生于72 h内,且与CMBs数量密切相关,但与CMBs病灶部位无关.

Objective To investigate the correlation between cerebral microbleeds （CMBs） and early neurological deterioration （END） in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enrolled prospectively. The clinical data, imaging data, and laboratory data were collected. END was defined as the National Institutes of Health Stroke Scale （NIHSS） score increased ≥2 within 7 d compared with the baseline. Susceptibility-weighted imaging was used to detecte CMBs. Multivariate logistic regression analysis was used to identify the independent correlation between CMBs and END. Results A total of 246 patients with acute acute ischemic stroke were enrolled. The incidence of END was 38. 21% （94/246）, 72. 34% （68/94） occurred within 72 h and 21. 28% （20/94） occurred from 72 h to 7 d. The detection rate of CMBs in the END group was 72. 34% （68/94） and that of CMBs in the non-END group was 43. 42% （66/152）. There was significant difference between the two groups （χ2 = 19. 587, P 〈 0. 001）. Multivariate logistic regression analysis showed that previous stroke or transient ischemic attack （odds ratio [ OR ] 1. 883, 95% confidence interval [ CI ] 1. 284- 2. 277; P = 0. 033 ）, large artery atherosclerosis （OR 4. 119, 95% CI 2. 564-5. 771; P = 0. 003）, baseline NIHSS score （OR 1. 682, 95% CI 1. 320-1. 876; P = 0. 042）, severe stroke （OR 4. 228, 95% CI 2. 634-5. 917; P = 0. 003）, onset to admission time （OR 2. 070, 95% CI 1. 454-2. 582; P = 0. 029）, and number of CMB ≥10 （OR 2. 728, 95% CI 1. 834- 3. 217; P = 0. 016） were the independent risk factors for END. Conclusions END is common in patients with acute ischemic stroke, most of them occurred within 72 h. It is closely associated with the number of CMB, but it is not associated with the location of CMB lesions.