大脑中动脉M1段闭塞性卒中患者液体衰减反转恢复序列血管高信号与临床转归的相关性

Correlation of fluid-attenuation inversion recovery vascular hyperintensity and clinical outcome in patients with middle cerebral artery M1 occlusive stroke

目的探讨急性大脑中动脉M1段闭塞性卒中患者液体衰减反转恢复序列(fluid-attenuated inversion recovery,FLAIR)血管高信号征(FLAIR vascular hyperintensity,FVH)与临床转归的相关性。方法回顾性纳入安徽医科大学第二附属医院神经内科2018年6月至2019年9月期间收治的急性大脑中动脉M1段闭塞性卒中患者。收集人口统计学和临床资料,采用MRI图像进行弥散加权成像(diffusion-weighted imaging,DWI)-阿尔伯塔卒中项目早期CT评分(Alberta Stroke Program Early CT Score,ASPECTS)和FVH评分。在发病后90 d时应用改良Rankin量表(modified Rankin Scale,mRS)评价临床转归,0~2分定义为转归良好,>2分为转归不良。采用多变量logistic回归分析确定FVH与转归的独立相关性。结果共纳入65例急性大脑中动脉M1段闭塞性卒中患者,男性37例(56.9%),年龄(64.35±12.13)岁。29例(44.6%)转归良好,36例(55.4%)转归不良。转归良好组甘油三酯(P=0.037)、接受抗高血压药治疗(P=0.037)、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(P<0.001)、DWI-ASPECTS(P=0.017)以及FVH评分(P<0.001)与转归不良组差异有统计学意义。多变量logistic回归分析显示,FVH评分(优势比6.477,95%置信区间1.570~26.716;P=0.010)和NIHSS评分(优势比1.869,95%置信区间1.326~2.635;P<0.001)与转归不良显著独立相关,但DWI-ASPECTS与转归无显著独立相关性(优势比0.451,95%置信区间0.068~2.988;P=0.410)。结论FVH评分是急性大脑中动脉M1段闭塞性卒中患者转归不良的独立危险因素。

Objective To investigate the correlation of fluid-attenuation inversion recovery(FLAIR)vascular hyperintensity(FVH)and clinical outcome in patients with middle cerebral artery M1 occlusive stroke.Methods Patients with acute middle cerebral artery M1 occlusive stroke admitted to the Department of Neurology,the Second Affiliated Hospital of Anhui Medical University from June 2018 to September 2019 were enrolled retrospectively.The demographic and clinical data were collected.Diffusion-weighted imaging(DWI)-Alberta Stroke Program Early CT Score(ASPECTS)and FVH score were performed with MRI images.The modified Rankin Scale(MRS)was used to evaluate the clinical outcome at 90 d after onset.0-2 was defined as good outcome,and>2 was defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent correlation between FVH and the outcome.Results A total of 65 patients with acute middle cerebral artery M1 occlusive stroke were enrolled,including 37 males(56.9%).Their age was 64.35±12.13 years.Twenty-nine patients(44.6%)had a good outcome,and 36(55.4%)had a poor outcome.There were significant differences in triglyceride(P=0.037),antihypertensive drug treatment(P=0.037),baseline National Institutes of Health Stroke Scale(NIHSS)score(P<0.001),DWI-ASPECTS(P=0.017)and FVH score(P<0.001)between the poor outcome group and the good outcome group.Multivariate logistic regression analysis showed that FVH score(odds ratio 6.477,95%confidence interval 1.570-26.716;P=0.010)and NIHSS score(odds ratio 1.869,95%confidence interval 1.326-2.635;P<0.001)were significantly independently correlated with the poor outcome.However,there was no significant independent correlation between DWI-ASPECTS and the outcome(odds ratio 0.451,95%confidence interval 0.068-2.988;P=0.410).Conclusions FVH score is an independent risk factor for poor outcome in patients with acute middle cerebral artery M1 occlusive stroke.