磁敏感加权成像不对称的显著皮质静脉与急性缺血性卒中患者早期神经功能恶化的相关性

Correlation between asymmetrically prominent cortical veins on susceptibility-weighted imaging and early neurological deterioration in patients with acute ischemic stroke

目的探讨磁敏感加权成像(susceptibility weighted imaging,SWI)显示的不对称的显著皮质静脉(asymmetrically prominent cortical vein,APCV)与急性缺血性卒中患者早期神经功能恶化(early neurological deterioration,END)的相关性。方法回顾性纳入2016年10月至2018年9月期间在中山大学附属东华医院神经内科住院并在发病3 d内完成MRI检查的急性缺血性卒中患者。应用SWI评价APCV。END定义为发病后7 d内任何时间点美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NHISS)评分较基线时增加≥2分或运动项评分较基线时增加≥1分。应用多变量logistic回归分析确定APCV与END的独立相关性。结果共纳入133例急性缺血性卒中患者,其中男性93例,女性40例,中位年龄57.3岁(四分位数间距:47.5~67.5岁)。基线NIHSS评分(5.9±5.0)分。51例(38.3%)患者存在APCV,38例(28.6%)患者发生END。END组与非END组APCV、同侧大血管狭窄以及入院后接受抗凝治疗的患者构成比均差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,在校正年龄和性别后,APCV是急性缺血性卒中患者发生END的独立危险因素(优势比6.907,95%可信区间2.798~17.052;P<0.001)。结论SWI显示的APCV是急性缺血性卒中患者发生END的独立危险因素。

Objective To investigate the correlation between asymmetrically prominent cortical veins(APCV)on susceptibility-weighted imaging(SWI)and early neurological deterioration(END)in patients with acute ischemic stroke.Methods From October 2016 to September 2018,patients with acute ischemic stroke admitted to the Department of Neurology,Donghua Hospital Affiliated to Sun Yat-sen University were enrolled retrospectively.They completed MRI within 3 d of onset.APCV was evaluated using SWI.END was defined as the National Institutes of Health Stroke Scale(NHISS)score at any time point within 7 d after the onset increased by≥2 or the motor function item score increased by≥1 from baseline.Multivariate logistic regression analysis was used to determine the independent correlation between APCV and END.Results A total of 133 patients with acute ischemic stroke were enrolled,including 40 females and 93 males,with a median age of 57.3 years(interquartile range:47.5-67.5 years).Baseline NIHSS score was 5.9±5.0.Fifty-one(38.3%)patients had APCV,and 38(28.6%)had END.The proportions of APCV,ipsilateral large vessel stenosis,and patients receiving anticoagulation after admission were significantly different between the END group and the non-END group(P<0.05).Multivariate logistic regression analysis showed that after adjusting for age and gender,APCV was an independent risk factor for END in patients with acute ischemic stroke(odds ratio 6.907,95%confidence interval 2.798-17.052;P<0.001).Conclusions APCV on SWI was an independent risk factor for END in patients with acute ischemic stroke.