脑白质疏松严重程度与急性前循环大血管闭塞性脑卒中机械取栓治疗预后的相关性研究

Association of degrees of leukoaraiosis severity with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy

目的探讨脑白质疏松严重程度是否与急性前循环大血管闭塞性脑卒中机械取栓治疗预后相关。方法连续收集自2016年1月至2017年8月在浙江省人民医院神经内科接受机械取栓治疗的146例急性前循环大血管闭塞性脑卒中患者的临床资料,根据术前脑白质疏松程度将患者分为无至中度脑白质疏松组和重度脑白质疏松组,比较2组患者的基线资料、手术成功再灌注率、术后24h内症状性颅内出血发生率、术后90d预后良好[改良Rankin量表(mRS)评分≤2分]率和术后90d死亡率;根据预后差异将患者分为预后良好组和预后不良组,采用单因素分析及多因素Logistic回归分析评估脑白质疏松程度与术后90d预后的关系。结果146例患者中,无至中度脑白质疏松组100例,重度脑白质疏松组46例;与无至中度脑白质疏松组相比,重度脑白质疏松组的年龄更大[70.50(59.75,79.75)岁vs.79(73,82)岁],基线美国国立卫生研究院卒中量表(NIHSS)评分更高[20(16,25)分vs.22(18,28)分],手术成功再灌注率更低[97.0%(97/100)vs.84.8%(39/46)],术后24h内症状性颅内出血发生率更高[11.0%(11/100)vs.26.1%(12/46)],术后90d预后良好率更低[54.0%(54/100)vs.21.7%(10/46)],术后90d死亡率更高[14.0%(14/100)vs.30.4%(14/46)],差异均有统计学意义(P<0.05)。146例患者中,预后良好组64例,预后不良组82例;单因素分析显示,与预后良好组相比,预后不良组的年龄更大[70.50(59.75,79.75)岁vs.79(73,82)岁],基线NIHSS评分更高[20(16,25)分vs.22(18,28)分],TOAST病因学分型中心源性栓塞型比例更高[68.8%(44/64)vs.76.8%(63/82)],重度脑白质疏松比例更高[15.6%(10/64)vs.43.9%(36/82)],差异均有统计学意义(P<0.05);多因素Logistic回归分析显示重度脑白质疏松(OR=3.109,95%CI:1.241~7.788,P=0.015)与年龄、基线NIHSS评分、TOAST病因学分型均是术后90d预后不良的独立危险因素(P<0.05)。结论重度脑白质疏松与急性前循环大血管闭塞性脑卒中机械取栓治疗预后不良独立相关。

Objective To assess whether degrees of leukoaraiosis (LA) severity is associated with prognoses of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy. Methods Clinical data of patients with acute anterior circulation large-artery occlusive stroke who underwent mechanical thrombectomy in our hospital from January 2016 to August 2017 were collected. The subjects were divided into non-to-moderate LA group and severe LA group according to preoperative degrees of LA severity;the baseline data, successful reperfusion rate, and symptomatic intracranial hemorrhage rate within 24 h of surgery, good prognosis rate 90 d after surgery(modified Rankin scale [mRS] scores≤2) and mortality 90 d after surgery were analyzed. According to the prognoses, the patients were divided into good prognosis group and poor prognosis group;univariate regression analysis and multivariate Logistic regression analysis were used to evaluate the relations of degrees of LA severity with prognoses 90 d after surgery. Results In these 146 patients, 100 patients were into the non-to-moderate LA group and 46 patients were into the severe LA group. As compared with patients in the non-to-moderate LA group, patients in the severe LA group had significantly older age (70.50 [59.75, 79.75] years vs. 79 [73, 82] years), significantly higher baseline NIHSS scores (20[16, 25]) vs. 22 [18, 28]), significantly higher rate of symptomatic intracranial hemorrhage 24 h after surgery (11.0%[11/100]) vs. 26.1%[12/46]), statistically higher mortality rate 90 d after surgery (14.0%[14/100]) vs. 14.0%[14/46]), significantly lower successful reperfusion rate (97.0%[97/100] vs. 84.8%[39/46]), and statistically lower good prognosis rate (54.0%[54/100] vs. 21.7%[10/46], P<0.05). Among the 146 patients, 64 had good prognosis and 82 had poor prognosis;univariate analysis showed that as compared with than those from the good prognosis group, patients from the poor prognosis group had significantly older age (70.50 [59.75, 79.75] years old vs. 79 [73, 82] years old) and statistically higher baseline NIHSS scores (20 [16, 25] vs. 22 [18, 28]), and significantly higher proportion of central source embolism by TOAST etiology classification (68.8%[44/64] vs. 76.8%[63/82]) and proportion of severe LA (15.6%[10/64] vs. 43.9%[36/82], P<0.05);multivariate Logistic regression analysis showed that severe LA (OR=3.109, 95%CI: 1.241-7.788, P=0.015), age, baseline NIHSS scores, and TOAST etiology classification were all independent risk factors for poor prognosis 90 d after surgery (P<0.05). Conclusion Severe LA may be associated with poor prognosis of patients with acute anterior circulation large-artery occlusive stroke after mechanical thrombectomy.