中重度脑白质疏松对急性缺血性脑卒中血管内治疗预后的影响

Influence of moderate to severe leukoaraiosis in prognoses of acute ischemic stroke patients after endovascular treatment

目的探讨中重度脑白质疏松与急性缺血性脑卒中血管内治疗预后的关系。方法对自2017年1月至2018年12月于苏北人民医院神经内科行血管内治疗且再通成功的60例急性前循环大血管闭塞患者,于治疗前依据头颅CT检查影像及vanSwieten量表评估脑白质疏松的严重程度(2~4分定义为中重度脑白质疏松),于治疗后90d时依据改良Rankin量表(mRS)评分分为预后不良组及预后良好组,采用单因素分析比较预后不良组与预后良好组间临床资料的差异,进一步采用多因素Logistic回归分析探讨中重度脑白质疏松对血管内治疗预后不良的影响。结果60例患者中,无脑白质疏松18例,轻度脑白质疏松19例,中重度脑白质疏松23例;预后不良32例,预后良好28例。单因素分析显示,预后不良组较预后良好组中重度脑白质疏松比例更高[59.4%(19/32)vs.14.3%(4/28)]、基线美国国立卫生研究院卒中量表(NIHSS)评分更高[(23.4±10.1)分vs.(14.7±7.0)分]、基线舒张压更高[(87.5±18.9)mmHgvs.(78.3±15.1)mmHg]、高血压病史比例更高[68.8%(22/32)vs.42.9%(12/28)]、年龄更大[(70.6±9.4)岁vs.(61.3±12.5)岁],差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示中重度脑白质疏松(OR=5.032,95%CI:1.026~24.679,P=0.046)、基线NIHSS评分是影响血管内治疗预后不良的独立危险因素。结论伴有中重度脑白质疏松的急性缺血性脑卒中患者血管内治疗预后不良的可能性更大。

Objective To investigate the influence of moderate to severe leukoaraiosis (LA) in prognoses of acute ischemic stroke patients after endovascular treatment. Methods From January 2017 to December 2018, 60 patients with acute ischemic stroke due to anterior circulation large vessel occlusion underwent endovascular treatment and obtained complete vessel recanalization in our hospital were evaluated for degrees of LA severity according to head CT scan and van Swieten scale (2-4 scores were defined as moderate-severe LA). According to modified Rankin scale (mRS) scores 90 d after treatment, the patients were divided into poor prognosis group and good prognosis group. Univariate analysis was used to compare the differences of influencing factors of the two groups. Multivariate Logistic regression analysis was further used to explore the influence of moderate to moderate-severe LA in poor prognosis of patients after endovascular treatment. Results Of the 60 patients, 18 did not have LA, 19 had mild LA, and 23 had moderate-severe LA;32 had poor prognosis and 28 had good prognosis. Univariate analysis showed that the patients from the poor prognosis group had significantly higher proportion of moderate-severe LA (59. 4%[19/32] vs. 14.3%[4/28]), significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores ([23.4±10.1] vs.[14.7±7.0]), significantly higher baseline diastolic blood pressure ([87.5±18.9] mmHg vs.[78.3±15.1] mmHg), significantly higher proportion of patients with hypertension history (68.8%[22/32] vs. 42.9%[12/28]), and statistically older age ([70.6±9.4] years vs.[61.3±12.5] years) than the patients from the good prognosis group (P<0.05). On multivariable Logistic regression analysis, the presence of moderate-severe LA (OR=5.032, 95%CI: 1.026-24.679, P=0.046) and baseline NIHSS scores were independent risk factors for poor prognosis of patients after endovascular treatment. Conclusion Patients with acute ischemic stroke accompanied with moderate-severe LA are more likely to have poor prognosis after endovascular treatment.