中重度脑白质疏松对急性轻型缺血性卒中早期神经功能恶化的影响

Influence of moderate to severeleukoaraiosis on early neurological deterioration in patients with acute minor stroke

目的脑小血管病对急性轻型缺血性卒中早期神经功能恶化造成影响目前尚无定论。文中探讨中重度脑白质疏松与急性轻型缺血性卒中早期神经功能恶化的关系。方法回顾性分析2019年1月至2019年12月于江苏省苏北人民医院神经内科住院治疗的69例急性轻型缺血性卒中患者临床资料。根据Fazekas量表评价脑白质疏松的严重程度(3~6分定义为中重度脑白质疏松),于人院72 h内复评美国国立卫生研究院卒中量表(NIHSS)评分,总分较入院时增加≥2分或运动功能缺损波动≥1分即发生早期神经功能恶化。根据患者发生早期神经功能恶化情况分为早期恶化组和非早期恶化组。采用多因素Logistic回归分析中重度脑白质疏松对急性轻型缺血性卒中早期神经功能恶化的影响。结果69例患者中,发生早期神经功能恶化22例。早期恶化组患者中重度脑白质疏松(68.2%rs 25.5%)、责任动脉狭窄≥50%(68.2%ts 6.4%)、多发病灶(27.3%us 2.1%)患者比例显著高于非早期恶化组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示中重度脑白质疏松(OR=4.808,95%CI:1.148~20.142,P=0.032)、责任动脉狹窄≥50%(OR=17.901,95%Cl:3.624~88.437,P=0.000)是影响急性轻型缺血性卒中早期神经功能恶化的独立危险因素。结论中重度脑白质疏松可能是急性轻型缺血性卒中早期神经功能恶化风险增高的危险因素。

Objective To investigate the relationship between moderate to severe leukoaraiosis(LA)and early neurological deterioration in patents with acute mior stroke.Methods From January to December 2017,69 patients with acute minor stroke in our hospital were evaluated for degrees of LA severity according to Fazekas scale(3-6 scores were defined as moderatec-severe LA).Early neurological deterioration was defined as any worsening of NIHSS score within 72 hours after admission.Multivariate logistie re-gression analysis was used to explore the influence of moderate to moderate-severe LA on early neurological deterioration.Results Among the 69 patients,22 cases were experienced early neurological deterioration.The patients from the early neurological deterioration group had significanly higher proportion of 1 moderate-severe LA,higher proportion of moderate-severe stenosis degree of the criminal artery and higher proportion of muliplex lesions.Multivariable logistic regression analysis showed that the presence of moderate-severe I.A(OR=4.808,95%CI:1.148-20.142,P=0.032)and moderate-se-vere stenosis degree of the criminal artery were independent risk fac-tors for early neurological deterioration of patients with acute minor stroke.Conclusion Patients with acute minor stroke accompanied with moderate-severe LA are more likely to have early neurological deterioration.