扩大的血管周围间隙对脑出血患者预后的影响

The influence of enlarged perivascular spaces on the prognosis of patients with intracerebral hemorrhage

目的探讨扩大的血管周围间隙(EPVS)对脑出血患者预后的影响。方法共306例脑出血患者以CT结果为依据,采用多田公式计算脑出血量,MRI评价扩大的血管周围间隙数目和分级,于发病后90 d采用改良Rankin量表(mRS)和欧洲五维健康量表(EQ-5D)评价功能恢复和生活质量,随访1年记录1年内脑卒中复发情况。结果共306例患者根据有无扩大的血管周围间隙分为EPVS组(129例)和无EPVS组(177例),EPVS组患者功能预后不良比例[75.97%(98/129)对36.16%(64/177);χ~2=47.469,P=0.000]和生活质量较差比例[44.19%(57/129)对20.34%(36/177);χ~2=20.058,P=0.000]均高于无EPVS组。亚组分析显示,EPVS轻度组患者功能预后不良比例[52%(39/75)对77.78%(42/54);χ~2=8.929,P=0.003]和生活质量较差比例[25.33%(19/75)对55.56%(30/54);χ~2=12.173,P=0.000]均低于重度组。EPVS组脑出血1年内出血性卒中复发率[6.98%(9/129)对1.13%(2/177);校正χ~2=5.770,P=0.016]和缺血性卒中复发率[12.40%(16/129)对2.82%(5/177);χ~2=10.710,P=0.001]均高于无EPVS组。结论存在扩大的血管周围间隙的脑出血患者预后不良,生活质量较差,1年内脑卒中复发率较高;扩大的血管周围间隙可以作为脑出血患者预后不良的预测因素。

Objective To investigate the impact of enlarged perivascular spaces （EPVS） on the prognosis of patients with intracerebral hemorrhage （[CH）. Methods A total of 306 ICH patients were enrolled in this study. The bleeding volume was calculated by Tada formula based on CT. The number and grade of EPVS were evaluated by MRI. Participants were assessed at 90 d after onset for functional outcome by the modified Rankin Scale （mRS） and quality of life by EuroQol Five Dimensions Questionnaire （EQ-5D）. The cerebrovascular events were recorded within one-year follow-up. Results Patients were divided into EPVS group （N = 129） and non-EPVS group （N = 177）. The rate of poor functional outcome [75.97% （98/129） vs. 36.16% （64/177）; χ2= 47.469, P = 0.000] and the rate of poor quality of life [44.19% （57/129） vs. 20.340/0 （36/177）; χ2 = 20.058, P = 0.000] in EPVS group were significantly higher than those in non-EPVS group. Subgroup analysis showed the rate of poor functional outcome [52% （39/75） vs. 77.78% （42/54）; χ2 = 8.929, P = 0.003] and the rate of poor quality of life [25.33% （19/75） vs. 55.56% （30/54）; χ2 = 12.173, P = 0.000] in mild EPVS group were significantly lower than those in severe EPVS group. During follow-up period, the recurrence rate of hemorrhagic stroke [6.98% （9/129） vs. 1.13% （2/177）; adjusted χ2=5.770, P = 0.016] and ischemic stroke [12.40% （16/129） vs. 2.82% （5/177）; χ2= 10.710, P = 0.001] in EPVS group were significantly higher than those in non-EPVS group. Conclusions ICH patients with EPVS have poor functional outcome, poor quality of life and high risk of reeurrent eerebrovascular events within one year. EPVS can be the predictor for poor prognosis of ICH patients.