急性缺血性卒中患者脑小血管病总负荷与静脉溶栓治疗转归的关系研究

Correlation between Total Burden of Cerebral Small Vessel Disease and Outcome after Intravenous Thrombolysis in Acute Ischemic Stroke Patients

目的探讨急性缺血性卒中(acute ischemic stroke,AIS)患者脑小血管病(cerebral small vessel disease,CSVD)总体负荷与静脉溶栓治疗转归的关系。方法回顾性纳入2012年3月-2018年1月于同济大学附属同济医院神经内科接受静脉溶栓治疗的AIS患者,根据头颅MRI评估CSVD总体负荷(CSVD总负荷评分),在发病后90 d时采用mRS量表评估患者预后,良好预后定义为mRS评分≤2分。使用多因素Logistic回归分析AIS静脉溶栓患者90 d预后不良(mRS评分≥3分)及住院期间并发症(住院期间新发的肺部感染、消化道出血和泌尿道感染)的独立影响因素。结果最终纳入178例患者,平均年龄62.3±10.5岁,其中男性125例(70.2%)。90 d预后良好患者共128例(71.9%)。多因素分析显示:糖尿病(OR 2.919,95%CI 1.044~8.162,P=0.041),吸烟(OR 7.752,95%CI 2.300~26.192,P=0.001),心房颤动(OR 6.553,95%CI 1.733~24.785,P=0.006),基线NIHSS评分(每增加1分:OR 1.354,95%CI 1.224~1.497,P<0.001),CSVD总负荷评分≥3分(OR 3.787,95%CI 1.127~12.728,P=0.031)是AIS患者静脉溶栓90 d预后不良的独立危险因素。基线NIHSS评分(每增加1分:OR 1.266,95%CI 1.163~1.377,P<0.001)及CSVD总负荷评分≥3分(OR 4.643,95%CI 1.562~13.801,P=0.006)是AIS静脉溶栓患者住院期间并发症的独立危险因素。结论CSVD总负荷评分≥3分是静脉溶栓患者90 d不良预后的独立危险因素。

Objective To investigate the relationship between the overall burden of cerebral small vessel disease(CSVD)and in-hospital outcomes after intravenous thrombolysis in acute ischemic stroke(AIS)patients.Methods AIS patients who underwent intravenous thrombolysis with rt-PA in Department of Neurology,Tongji Hospital from March,2012 to January,2018 were retrospectively analyzed.The total CSVD score was assessed based on brain MRI.90-day prognosis was evaluated by using mRS,and good prognosis was defined as a mRS score of 0 to 2.Multivariate logistic regression was used to analyze the influencing factors associated with 90-day poor prognosis(mRS score≥3)and inhospital complications after intravenous thrombolysis in AIS patients.Results A total of 178 patients were included,with a mean age of 62.3±10.5 years and 125 males(70.2%).128 patients(71.9%)had good prognosis at 90 days.Multivariate analysis showed that diabetes(OR 2.919,95%CI 1.044-8.162,P=0.041),smoking(OR 7.752,95%CI 2.300-26.192,P=0.001),atrial fibrillation(OR 6.553,95%CI 1.733-24.785,P=0.006),NIHSS score at admission(OR 1.354,95%CI 1.224-1.497,P<0.001)and total CSVD score≥3 points(OR 3.787,95%CI 1.127-12.728,P=0.031)were independent risk factors for poor prognosis in AIS patients treated with intravenous thrombolysis.NIHSS score at admission(OR 1.266,95%CI 1.163-1.377,P<0.001)and total CSVD score≥3 points(OR 4.643,95%CI 1.562-13.801,P=0.006)were independent risk factors for in-hospital complications in AIS patients treated with intravenous thrombolysis.Conclusions The total CSVD score≥3 points was independent risk factor for 90-day poor prognosis after intravenous thrombolysis in AIS patients.