动脉粥样硬化性大脑中动脉慢性闭塞患者FLAIR高信号血管征的临床意义

Clinical significance of FLAIR vascular hyperintensities in patients with chronic atherosclerotic middle cerebral artery occlusion

目的:探讨动脉粥样硬化性大脑中动脉慢性闭塞患者液体衰减反转恢复序列(fluid-attenuated inversion recovery, FLAIR)高信号血管征(FLAIR vascular hyperintensities, FVHs)的临床意义。方法:纳入2016年7月至2020年11月期间在扬州市江都人民医院神经内科住院并首次发现的粥样动脉硬化性大脑中动脉慢性闭塞患者。收集人口统计学、临床资料以及MRI影像学资料。根据有无急性脑梗死,将患者分为非脑梗死组和脑梗死组;根据发病3个月后改良Rankin量表评分,将脑梗死患者进一步分为转归良好组(≤2分)和转归不良组(>2分)。应用多变量 logistic回归模型分析FVHs与动脉粥样硬化性大脑中动脉慢性闭塞患者脑梗死风险以及脑梗死患者转归的独立相关性。 结果:共纳入粥样动脉硬化性大脑中动脉慢性闭塞患者94例,其中非急性脑梗死患者38例(40.4%),急性脑梗死患者56例(59.6%);在急性脑梗死患者中,13例(23.2%)转归不良,43例(76.8%)转归良好。脑梗死组纤维蛋白原水平、存在FVHs的患者比例以及FVHs评分均显著高于非脑梗死组( P均<0.05);多变量 logistic回归分析显示,FVHs评分与急性脑梗死风险呈显著独立正相关(优势比2.524,95%置信区间1.400~4.552;P=0.002)。转归不良组入院时美国国立卫生研究院卒中量表评分、入院时改良Rankin量表评分以及FVHs评分均显著高于转归良好组( P均<0.05);多变量 logistic回归分析显示,FVHs评分与脑梗死患者转归良好呈显著独立负相关(优势比0.144,95%置信区间0.045~0.459;P=0.001)。 结论:FVHs提示血供处于失代偿状态。当存在FVHs时,大脑中动脉慢性闭塞患者发生脑梗死的风险显著增高;FVHs范围越广,脑梗死后转归不良风险越高。

Objective To investigate the clinical significance of fluid-attenuated inversion recovery(FLAIR)vascular hyperintensities(FVHs)in patients with chronic atherosclerotic middle cerebral artery occlusion.Methods From July 2016 to November 2020,patients admitted to the Department of Neurology,Jiangdu People's Hospital of Yangzhou and first found chronic atherosclerotic middle cerebral artery occlusion were enrolled.The demographic,clinical and MRI imaging data were collected.According to the presence or absence of acute cerebral infarction,they were divided into the non-acute cerebral infarction group and the acute cerebral infarction group.According to the modified Rankin Scale score at 3 months after the onset,patients with acute cerebral infarction were further divided into the good outcome group(≤2)and the poor outcome group(>2).A multivariate logistic regression model was used to analyze the independent correlation between FVHs and the risk of cerebral infarction in patients with chronic atherosclerotic middle cerebral artery occlusion and the outcome in patients with cerebral infarction.Results A total of 94 patients with chronic atherosclerotic middle cerebral artery occlusion were enrolled,including 38 with non-acute cerebral infarction(40.4%)and 56 with acute cerebral infarction(59.6%).In patients with acute cerebral infarction,13(23.2%)had a poor outcome,and 43(76.8%)had a good outcome.The fibrinogen level,the proportion of patients with FVHs and the FVHs score in the cerebral infarction group were significantly higher than those in the non-cerebral infarction group(all P<0.05).Multivariate logistic regression analysis showed that the FVHs score was significantly,independently,and positively correlated with the risk of acute cerebral infarction(odds ratio 2.524,95%confidence interval 1.400-4.552;P=0.002).The National Institutes of Health Stroke Scale score at admission,the modified Rankin Scale score at admission,and FVHs score in the poor outcome group were significantly higher than those in the good outcome group(all P<0.05).Multivariate logistic regression analysis showed that there was a significant independent negative correlation between the FVHs score and the outcome of patients with cerebral infarction(odds ratio 0.144,95%confidence interval 0.045-0.459;P=0.001).Conclusions FVHs suggest that the blood supply is in a state of decompensation.When FVHs are present,the risk of cerebral infarction in patients with chronic middle cerebral artery occlusion is significantly increased;the wider the range of FVHs,the higher the risk of poor outcome after cerebral infarction.