脑白质高信号与前循环大血管闭塞性卒中患者侧支循环状况的相关性

Correlation between white matter hyperintensities and collateral circulation in patients with stroke caused by anterior circulation large vessel occlusion

目的探讨脑白质高信号(white matter hyperintensities,WMHs)与前循环大血管闭塞(anterior circulation large vessel occlusion,aLVO)所致卒中患者侧支循环的相关性。方法回顾性纳入2017年12月至2021年4月期间在郑州人民医院神经内科接受血管内机械血栓切除术治疗的aLVO患者。收集患者人口统计学、血管危险因素、基线临床资料、Fazekas量表评分等资料。采用多变量logistic回归分析确定WMHs与aLVO患者侧支循环状况的独立相关性。结果研究期间共纳入166例aLVO患者,男性77例(46.39%),年龄(69.62±5.91)岁,基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分为(9.33±4.42)分。侧支循环良好组120例(72.29%),侧支循环不良组46例(27.71%)。单变量分析显示,侧支循环良好组基线NIHSS评分、Fazekas总分以及脑室周围Fazekas评分与侧支循环不良组差异有统计学意义(P均<0.05)。多变量logistic回归分析显示,Fazekas总分(优势比2.583,95%置信区间1.445~4.619;P=0.001)及脑室周围Fazekas评分(优势比2.190,95%置信区间1.022~4.692;P=0.044)是侧支循环不良的独立危险因素。结论WMHs严重程度与aLVO患者侧支循环不良相关。

Objective To investigate the correlation between white matter hyperintensities(WMHs)and collateral circulation in patients with stroke caused by anterior circulation large vessel occlusion(aLVO).Methods Patients with stroke caused by aLVO treated with endovascular mechanical thrombectomy in the Department of Neurology,Zhengzhou People's Hospital from December 2017 to April 2021 were retrospectively enrolled.Their demography,vascular risk factors,baseline clinical data and Fazekas scale score were collected.Multivariate logistic regression analysis was used to determine the independent correlation between WMHs and the collateral circulation status in patients with aLVO.Results During the study,166 patients with aLVO were included(77 males,46.39%;aged 69.62±5.91 years).Their baseline National Institutes of Health Stroke Scale(NIHSS)score was 9.33±4.42.There were 120 patients(72.29%)in the good collateral circulation group and 46(27.71%)in the poor collateral circulation group.Univariate analysis showed that there were significant differences in baseline NIHSS score,total Fazekas score and periventricular Fazekas score between the good collateral circulation group and the poor collateral circulation group(all P<0.05).Multivariate logistic regression analysis showed that total Fazekas score(odds ratio 2.583,95%confidence interval 1.445-4.619;P=0.001)and periventricular Fazekas score(odds ratio 2.190,95%confidence interval 1.022-4.692;P=0.044)were the independent risk factors for the poor collateral circulation.Conclusion The severity of WMHs is associated with the poor collateral circulation in patients with aLVO.