年龄相关脑白质改变程度对中老年人远期首次症状性缺血性脑卒中影响的研究

Effect of age-related white matter changes on long-term first symptomatic ischemic stroke events in the oldsters

目的探讨年龄相关脑白质改变(ARWMC)程度对中老年人远期首次症状性缺血性脑卒中的影响。方法采用前瞻性研究设计,以自2010年1月至2012年8月在中山大学附属佛山医院神经内科住院的368例中老年脑小血管病患者为研究对象,应用MRI检查及ARWMC量表评估其ARWMC评分,并依据ARWMC评分将研究对象分为无ARWMC组、轻-中度ARWMC组和重度ARWMC组。每3个月随访1次,记录临床终点事件(包括首次症状性缺血性脑卒中、心肌梗死和全因死亡)的发生情况及时间。采用统计学方法比较不同程度ARWMC组间临床资料的差异,进一步采用COX回归分析评估不同程度ARWMC组间发生远期首次症状性缺血性脑卒中的风险差异。结果平均随访48.7个月后,有50例(13.6%)研究对象发生首次症状性缺血性脑卒中,其中重度ARWMC组25例(25.8%)、轻-中度ARWMC组22例(10.9%)、无ARWMC组3例(4.4%)。各组间年龄、高血压病史、收缩压、临床终点事件发生率、首次症状性缺血性脑卒中发生率及发生临床终点事件的随访时间比较差异均有统计学意义(P<0.05),其中重度ARWMC组年龄最大、有高血压病史率最高、收缩压最高、临床终点事件及首次症状性缺血性脑卒中发生率最高、发生临床终点事件的随访时间最短。COX回归分析显示,重度ARWMC组发生首次症状性缺血性脑卒中的风险较无ARWMC组提高约8倍[风险比(HR)=9.012,95%CI:2.310~35.154,P=0.002]。结论严重ARWMC多伴有高血压病史及血压控制欠佳,是中老年人远期首次症状性缺血性脑卒中严重的危险因素。

Objective To study the effect of age-related white matter changes (ARWMC) on first symptomatic ischemic stroke events in the oldsters. Methods For the prospective study, a total of 368 eligible oldsters were enrolled in the study from January 2010 to August 2012. The degrees of ARWMC were assessed by ARWMC scale;according to the scores, they were divided into non ARWMC group, mild-moderate ARWMC group and severe ARWMC group. The patients were followed up once every 3 months. The clinical endpoint events and time (first symptomatic ischemic stroke, myocardial infarction and all-cause death) were recorded. Analyses of variance and Chi-square test were used to compare the differences of clinical data among the 3 groups. COX regression was used to assess the risk differences of first symptomatic ischemic stroke in the oldsters of three groups. Results After an average of follow-up for 48.7 months, 50 participants (13.6%) had first symptomatic ischemic stroke;25 (25.8%) were categorized as the severe ARWMC group, 22 (10.9%) were as the mild-medium group, and 3 (4.4%) were as the non ARWMC group. Among the three groups, the differences in age, history of hypertension, systolic blood pressure, incidence of clinical endpoint events and first symptomatic ischemic stroke, and follow-up time of endpoint events were statistically significant (P<0.05);patients from the severe ARWMC group were the oldest, and had the longest history of hypertension, the highest systolic blood pressure, the highest incidence of clinical end events and first symptomatic ischemic stroke, and the shortest follow-up period for clinical end events. COX regression analysis showed that the risk of first symptomatic ischemic stroke in the severe ARWMC group was about 8 times higher than that in the non ARWMC group (hazard ratio=9.012, 95%CI: 2.310-35.154, P=0.002). Conclusion In oldsters, severe ARWMC often accompany hypertension history and poor blood pressure controll, and it is an independent and serious risk factor for long-term first symptomatic ischemic stroke.