急性缺血性脑卒中患者DWI阴性的影响因素及其预后研究

Influencing factors and outcomes of patients with acute ischemic stroke having negative results in diffusion weighted imaging

目的探讨急性缺血性脑卒中患者磁共振弥散加权成像(DWI)阴性的影响因素及其预后。方法采用前瞻性研究设计,连续选择自2016年10月至2018年1月在徐州医科大学第二附属医院神经内科住院治疗的急性缺血性脑卒中患者为研究对象,收集其人口统计学、基线特征、影像学检查和实验室检查等临床资料,并依据首次DWI信号分为DWI阳性组与DWI阴性组,采用单因素分析及多因素Logistic回归分析筛选DWI阴性的影响因素。对DWI阴性组患者于首次检查1周后复查DWI观察信号改变情况。所有患者随访至发病后90 d,并采用改良Rankin量表(mRS)评分评估预后。结果最终纳入的312例急性缺血性脑卒中患者中,DWI阴性率为12.82%(40/312)。多因素Logistic回归分析显示轻度脑卒中(OR=2.533,95%CI:1.436~3.984,P= 0.038)、小动脉闭塞型(OR=4.236,95%CI:2.448~6.348,P=0.009)、脑干病灶(OR=1.629,95%CI:1.035~2.693,P=0.049)、腔隙性梗死(OR=4.668,95%CI:2.203~6.543,P=0.005)、发病时间在超早期(OR=4.074,95%CI:2.683~6.576,P=0.013)是DWI阴性的独立影响因素。DWI阴性组患者复查DWI示阴性率降低至7.05%(22/312)。发病后90 d时,完成随访的302例患者中DWI阴性组40例,其预后不良率为27.50%(11/40);DWI阳性组262例,其预后不良率为30.15%(79/262);2组预后不良率差异无统计学意义(P>0.05)。结论急性缺血性脑卒中患者首次DWI阴性与脑卒中严重程度、TOAST病因学分型、病灶部位、病灶大小及发病时间密切相关,而复查DWI可以降低DWI阴性率。DWI阴性患者的预后并不优于DWI阳性患者,故发病时间在超早期内的DWI阴性患者不应该被排除在静脉溶栓之外。

ObjectiveTo investigate the influencing factors and outcomes of patients with acute ischemic stroke having negative results in diffusion weighted imaging (DWI). MethodsIn prospective study, the patients with acute ischemic stroke, admitted to our hospital from October 2016 to January 2018, were selected as research subjects. The demographic and baseline characteristics, imaging data and laboratory examination data were collected. According to the signals of first DWI, the patients were divided into positive DWI group and negative DWI group. The influencing factors of negative results in DWI were clearly defined by univariate and multivariate Logistic regression analyses. The patients from negative DWI group were rechecked for DWI one week after first DWI. All patients were followed up for 90 d, and the outcomes were evaluated by modified Rankin scale (mRS). ResultsA total of 312 patients with acute ischemic stroke were enrolled finally. The negative rate of DWI was 12.82%(40/312). Multivariate Logistic regression analysis showed that mild stroke (odds ratio [OR]= 2.533, 95% confidence interval[CI]: 1.436-3.984, P=0.038), lacunar infarction (OR=4.668, 95%CI: 2.203-6.543, P=0.005), arteriole occlusion (OR=4.236, 95%CI: 2.448-6.348, P=0.009), brainstem lesion(OR=1.629, 95%CI: 1.035-2.693, P=0.049) and time of onset within hyper-acute period (OR=4.074, 95%CI: 2.683-6.576, P=0.013) were influencing factors for negative results in DWI. The negative rate of DWI in the negative DWI group was reduced to 7.05%(22/312) one week after first DWI. Totally, 302 patients finished the 90 d of follow up;40 patients were into the negative DWI group, with poor outcome rate of 27.50%(11/40);262 patients were into the positive DWI group, with poor outcome rate of 30.15%(79/262);the difference of poor outcome rates between the two groups was not statistically significant (P>0.05). ConclusionsThe negative results in DWI in patients with acute ischemic stroke are closely related to severity of stroke, TOAST etiological types, locations of the lesions, sizes of the lesions and time of onset. Review of DWI can reduce negative rate of DWI. The outcomes of patients with acute ischemic stroke having negative results in DWI are not better than those with positive results in DWI. The patients with acute ischemic stroke having negative results in DWI and having onset within hyper-acute period should not be excluded from intravenous thrombolytic treatment.