脑白质疏松与老年急性脑梗死静脉溶栓患者症状性颅内出血及功能预后的关系研究

Impact of Leukoaraiosis on Symptomatic Intracranial Hemorrhage and Functional Outcome after Intravenous Thrombolysis in Elderly Patients with Acute Cerebral Infarction

目的探讨脑白质疏松与老年急性脑梗死静脉溶栓患者症状性颅内出血(symptomatic intracranial hemorrhage,sICH)及功能预后的关系。方法纳入2016年1月1日-2018年12月31日连续就诊于北京怀柔医院的老年急性脑梗死静脉溶栓患者。根据入院头颅CT,采用改良Van Swieten量表进行脑白质疏松分级。应用多因素Logistic回归模型,分析脑白质疏松与溶栓后24 h sICH和3个月不良功能预后(mRS>2分)的关系。结果共纳入125例患者,平均年龄73.2±8.4岁,男性84例(67.2%),有脑白质疏松82例(65.6%)。有脑白质疏松、无脑白质疏松患者溶栓后24 h sICH发生率分别为12.2%(10/82)、4.7%(2/43),P=0.298;3个月不良功能预后比例分别为70.7%(58/82)、34.9%(15/43),P<0.001。多因素Logistic回归分析显示,脑白质疏松与老年急性脑梗死静脉溶栓患者24 h sICH不相关(OR 0.320,95%CI 0.056~1.846,P=0.203);与3个月不良功能预后独立相关(OR 4.392,95%CI 1.514~12.744,P=0.006)。结论脑白质疏松症与老年急性脑梗死静脉溶栓患者sICH不相关,但与静脉溶栓治疗后3个月不良功能预后独立相关。

Objective To investigate the impact of leukoaraiosis(LA)on symptomatic intracranial hemorrhage(sICH)within 24 hours after intravenous thrombolysis and 3-month functional outcome in elderly patients with acute ischemic stroke.Methods The elderly patients who received intravenous thrombolysis in Beijing Huairou Hospital from January 1,2016 to December 31,2018 were selected.Based on the head CT evaluation at admission.LA was graded using modifed Van Swieten scale.Multivariate logistic regression model was used to analyze the relationship between LA and sICH at 24 hours after thrombolysis and 3-month poor prognosis(mRS>2).Results A total of 125 patients were enrolled,with an average age of 73.2±8.4 years and 84 males(67.2%),of whom 82 patients(65.6%)had LA.The percentage of sICH in LA group and non-LA group was 12.2%(n=10)and 4.7%(n=2),P=0.298;and the percentage of poor prognosis was 70.7%(n=58)and 34.9%(n=15),P<0.001.Multivariate logistic regression analysis showed that LA was not correlated with sICH(OR 0.320,95%CI 0.056-1.846,P=0.203),but associated with 3-month poor prognosis(OR 4.392,95%CI 1.514-12.744,P=0.006).Conclusions LA was not associated with sICH within 24 hours after intravenous thrombolysis,but with poor prognosis at 3 months in elderly patients with acute cerebral infarction.