新发孤立脑干梗死患者1年预后的影响因素分析

Analysis of the Influencing Factors for 1-Year Prognosis of Patients with New Isolated Brainstem Infarction

目的分析不同临床及影像学特征对新发孤立脑干梗死患者1年预后的影响。方法通过中国颅内动脉粥样硬化研究登记数据,回顾性分析2007年10月-2009年6月连续收治的新发孤立脑干梗死患者的临床资料,收集患者的临床及影像学资料,以1年患者mRS>2分、卒中复发或死亡为不良结局事件,将患者分为无不良结局事件组和不良结局事件组。比较两组临床及影像学特征,分析新发孤立脑干梗死患者1年预后的影响因素。结果最终纳入281例新发孤立脑干梗死患者,中位年龄63(56~72)岁,男性179例(63.7%);不良结局事件组84例(29.9%),无不良结局事件组197例(70.1%)。两组临床资料比较结果显示,不良结局事件组年龄、入院时NIHSS评分、出院时mRS>2分比例及大动脉粥样硬化型比例均高于无不良结局事件组,差异有统计学意义。两组影像学特征比较结果显示,不良结局事件组Fazekas量表≥3分、脑干多组穿支动脉受累患者比例高于无不良结局事件组,梗死灶体积大于无不良结局事件组,差异有统计学意义;两组梗死灶部位指标差异有统计学意义,其中不良结局事件组梗死灶累计两个部位(脑桥合并中脑)患者比例高于无不良结局事件组。多因素logistic回归分析结果显示,出院时mRS>2分(OR 3.80,95%CI 1.75~8.23,P=0.001)、Fazekas量表≥3分(OR 2.66,95%CI 1.37~5.18,P=0.004)及脑干多组穿支动脉受累(OR 1.99,95%CI 1.06~3.74,P=0.032)是新发孤立脑干梗死患者1年预后的独立危险因素。结论脑干多组穿支动脉受累、出院时患者mRS>2分及Fazekas量表≥3分是新发孤立脑干梗死患者1年预后的独立危险因素,临床实践中需注意筛查和控制以上危险因素,以降低患者不良预后风险。

Objective To analyze the effects of different clinical and imaging features on 1-year prognosis of patients with new isolated brainstem infarction.Methods Based on the data of Chinese intracranial atherosclerosis registration study,the clinical and imaging data of consecutive patients with new isolated brainstem infarction from October 2007 to June 2009 were retrospectively analyzed.The adverse outcome events were defined as 1-year mRS>2,stroke recurrence or death.The patients were divided into no adverse outcome event group and adverse outcome event group.The clinical and imaging characteristics of the two groups were compared to analyze the influencing factors for 1-year prognosis of the patients with new isolated brainstem infarction.Results Finally,a total of 281 patients were included,with a median age of 63(56-72)years and 179 males(63.7%).There were 84 cases(29.9%)in the adverse outcome event group and 197 cases(70.1%)in no adverse outcome event group.The age,NIHSS at admission,mRS>2 at discharge,the proportion of atherosclerosis and Fazekas scale≥3 and multiple groups of brainstem perforating arteries involvement,infarct volume and the proportion of two infarct locations(pons and midbrain)in the adverse outcome event group were higher than those in no adverse outcome event group,and the above differences were statistically significant.Multivariate logistic regression analysis showed that mRS>2 at discharge(OR 3.80,95%CI 1.75-8.23,P=0.001),Fazekas scale≥3(OR 2.66,95%CI 1.37-5.18,P=0.004)and multiple groups of brainstem perforating arteries involvement(OR 1.99,95%CI 1.06-3.74,P=0.032)were independent risk factors for 1-year prognosis of patients with new isolated brainstem infarction.Conclusions Multiple groups of brainstem perforating arteries involvement,neurological impairment(mRS>2)at discharge and severe leukoaraiosis(Fazekas scale≥3)were independent risk factors for 1-year prognosis in patients with new isolated brainstem infarction.