急性缺血性卒中静脉溶栓患者不同部位脑白质疏松的影响因素分析

Influencing Factors of Leukoaraiosis at Different Brain Regions in Patients with Intravenous Thrombolysis for Acute Ischemic Stroke

目的探讨急性缺血性卒中(acute isch emic stroke,AIS)静脉溶栓患者不同部位脑白质疏松(Leukoaraiosis,LA)的影响因素。方法回顾性纳入2018年1月-2019年12月南京中医药大学附属徐州市中心医院神经内科连续收治且发病在4.5 h以内行阿替普酶静脉溶栓治疗的AI S患者。依据患者入院后72 h内完善的头颅MRI影像结果,采用Fazekas评分量表评估LA部位及严重程度,根据深部LA严重程度分为中重度深部LA组及无或轻度深部LA组;再根据脑室旁LA严重程度分为中重度脑室旁LA组及无或轻度脑室旁LA组。分别比较脑室旁与深部LA患者中组间临床特征(年龄、高血压,肌酐、Hcy水平等)差异,并应用多因素logistic回归分析,分别探讨脑室旁和深部LA严重程度的影响因素。结果最终纳入318例AI S患者,均给予阿替普酶静脉溶栓治疗。总体患者年龄41~91岁,平均65.4±11.6岁,男性211例(66.4%)。在深部LA分组中,中重度深部LA组89例,无或轻度深部LA组229例;在脑室旁LA分组中,中重度脑室旁LA组160例,无或轻度脑室旁LA组158例。单因素分析结果显示,在脑室旁LA分组中,中重度脑室旁LA组患者年龄、高血压比例,纤维蛋白原、肌酐及Hcy水平均高于无或轻度脑室旁LA组,LDL-C水平低于无或轻度脑室旁LA组;在深部LA分组中,中重度深部LA组年龄、高血压比例,纤维蛋白原及肌酐水平均高于无或轻度深部LA组,以上差异有统计学意义。多因素logistic回归分析结果显示,在脑室旁白质区域,高龄(OR 1.058,95%CI 1.034~1.082,P<0.001)、高血压(OR 1.900,95%CI 1.129~3.197,P=0.016)及Hcy水平升高(OR 1.053,95%CI 1.003~1.105,P=0.039)是AI S静脉溶栓患者中重度LA的独立危险因素;在深部白质区域,高龄(OR 1.050,95%CI 1.025~1.075,P<0.001)与高血压(OR 2.851,95%CI 1.514~5.369,P=0.001)是AIS患者中重度LA的独立危险因素。结论高龄与高血压是AIS静脉溶栓患者中重度LA的独立危险因素,而Hcy水平升高则是此类患者脑室旁中重度LA的独立危险因素。

Objective To investigate the factors influencing leukoaraiosis(LA)at different brain regions in patients with intravenous thrombolysis for acute ischemic stroke(AIS).Methods The data of AIS patients with rt-PA intravenous thrombolysis within 4.5 hours of onset who were admitted to Department of Neurology of Xuzhou Central Hospital,Nanjing University of Chinese Medicine from January 2018 to December 2019 were retrospectively analyzed.The Fazekas scale was used to assess the site and severity of LA.According to the site of LA,the patients were divided into deep LA subgroup and paraventricular LA subgroup;according to the severity of LA,the patients were divided into no or mild LA subgroup and moderate-severe LA subgroup.The clinical characteristics among patients with paraventricular and deep LA were compared.The multivariable logistic regression analysis was used to determine the risk factors of LA severity in different sites.Results A total of 318 eligible patients were included,with the mean age of 65.4±11.6 years(range:41-91 years)and 211 males(66.4%).For patients with deep LA,229 cases with no or mild LA and 89 cases with moderate-severe LA;for patients with paraventricular LA,158 cases with no or mild LA and 160 cases with moderate-severe LA.In paraventricular LA subgroup,age,percentage of hypertension,the level of blood Hcy,fibrinogen,and creatinine in moderate-severe LA subgroup were all higher than those in no or mild LA subgroup;in deep LA subgroup,age,percentage of hypertension,the level of blood fibrinogen and creatinine in moderate-severe LA subgroup were all higher than those in no or mild LA subgroup,all with statistical differences.The multivariable logistic regression analysis showed that elder(OR 1.058,95%CI 1.034-1.082,P<0.001),hypertension(OR 1.900,95%CI 1.129-3.197,P=0.016),increased blood Hcy level(OR 1.053,95%CI 1.003-1.105,P=0.039)were independent risk factors for moderate to severe LA in paraventricular area;age(OR 1.050,95%CI 1.025-1.075,P<0.001)and hypertension(OR 2.851,95%CI 1.514-5.369,P=0.001)were independent risk factors for moderate to severe LA in deep brain area.Conclusions Elder and hypertension were independent risk factors for moderate to severe LA in patients with intravenous thrombolysis for AIS,whereas increased blood Hcy level was an independent risk factor for moderate to severe paraventricular LA.