脑出血伴小的弥散加权成像高信号病变与脑小血管病总负荷的关系及对预后的影响

Association between small diffusion-weighted imaging hyperintensities lesions and total cerebral small vessel disease burden and the influence on prognosis in patients with acute intracerebral hemorrhage

目的探讨急性脑出血伴小的弥散加权成像(DWI)高信号病变与脑小血管病(cSVD)总负荷的关系及对预后的影响。方法连续收集2018年1月至2021年6月在郑州人民医院卒中中心收治的急性自发性脑出血患者。采用磁共振评估DWI高信号病变及cSVD影像标志物,包括脑白质高信号、扩大的血管周围间隙、腔隙、脑微出血,计算cSVD总负荷(0~4分);出院及90 d时采用改良Rankin量表(mRS)评估功能预后。采用多因素Logistic回归分析探讨急性脑出血患者DWI病变与cSVD的关系及对预后的影响。结果共纳入283例急性脑出血患者,其中59例(20.8%)存在小的DWI病变,32例(11.3%)有多个DWI病变,DWI病变多为点状、位于皮质/皮质下且分布在多个血管流域。随着cSVD负荷的增加,DWI病变数目逐渐增多,Spearman相关分析结果显示cSVD总负荷与DWI病变数呈正相关(r=0.21,P<0.001)。多因素回归分析结果显示,cSVD总负荷与DWI病变独立相关(OR=1.63,95%CI 1.23~2.15,P=0.001)。有DWI病变组90 d不良预后(mRS评分≥4分)比例显著高于无DWI病变组(39.3%比16.3%,χ^(2)=14.38,P<0.001),而出院时结局在两组间差异无统计学意义(26.5%比17.7%,χ^(2)=3.06,P=0.080)。随着DWI病变数目增多90 d不良预后显著增加(趋势χ^(2)检验χ^(2)=11.50,P=0.001)。多因素回归分析结果显示DWI病变(OR=4.39,95%CI 1.92~10.03,P<0.001)及其数目(OR=1.42,95%CI 1.06~1.90,P=0.018)与90 d不良预后独立相关。结论高的cSVD总负荷是脑出血患者小的DWI病变的独立危险因素,小的DWI病变与脑出血患者90 d不良预后独立相关,与出院时结局无关。

Objective To investigate the associations between small diffusion-weighted imaging(DWI)hyperintensities lesions and total cerebral small vessel disease(cSVD)burden and the influence on prognosis in patients with acute intracerebral hemorrhage(ICH).Methods Consecutive patients with acute spontaneous ICH from January 2018 to June 2021 were recruited in the Stroke Center of Zhengzhou People′s Hospital.Magnetic resonance imaging was performed to quantify DWI hyperintensities lesions and cSVD imaging markers,including white matter hyperintensities,enlarged perivascular spaces,lacunes and cerebral microbleeds,which were calculated for the total cSVD burden(0-4 points).The prognosis was assessed with the modified Rankin Scale(mRS)at discharge and 90-day.Multivariable Logistic regression models were adopted to explore the associations between DWI lesions and total cSVD burden and clinical outcome.Results Of 283 included patients,59(20.8%)had small DWI lesions,32(11.3%)had multiple lesions.They were mostly punctate,mainly located in the cortical and subcortical regions,and scattered in multiple vascular territories.With the increase of cSVD burden,the number of DWI lesions gradually increased.Spearman correlation analysis showed that the total cSVD burden was positively correlated with the number of DWI lesions(r=0.21,P<0.001).In multivariable regression analyses,the total cSVD burden was independently associated with DWI lesions(OR=1.63,95%CI 1.23-2.15,P=0.001).The 90-day poor outcome(mRS scores≥4)in patients with DWI lesions was significantly higher than those without DWI lesions(39.3%vs 16.3%,χ^(2)=14.38,P<0.001),while there was no statistically significant difference in the poor outcome of discharge between the two groups(26.5%vs 17.7%,χ^(2)=3.06,P=0.080).With the increase in the number of DWI lesions,the 90-day poor outcome increased significantly(trend chi-squared testχ^(2)=11.50,P=0.001).Multivariable analyses showed that DWI lesions(OR=4.39,95%CI 1.92-10.03,P<0.001)and their number(OR=1.42,95%CI 1.06-1.90,P=0.018)were independently associated with the 90-day poor outcome.Conclusions Higher total cSVD burden is an independent risk factor for small DWI lesions in patients with ICH.Small DWI lesions were independently associated with the 90-day poor outcome,but not with the discharge outcome.