脑小血管病影像学标志物与脑出血预后的相关性研究

Correlation between imaging markers of cerebral small vessel disease and prognosis of cerebral hemorrhage

目的观察脑小血管病(CSVD)总负荷评分与脑出血患者预后的相关性。方法回顾性分析2017年11月至2019年10月于浙江大学医学院附属第二医院神经内科连续收治住院的自发性脑出血患者330例。通过磁共振影像评估脑微出血、脑白质病变、无症状性腔隙性脑梗死及血管周围间隙扩大计算获得CSVD总负荷评分,收集脑出血患者发病90 d改良Rankin量表(mRS)评分作为评估预后的指标。比较不同临床资料特征患者发病90 d mRS评分,并观察CSVD总负荷评分与脑出血患者发病90 d mRS评分的相关性。结果临床资料显示合并脑出血史、高入院美国国立卫生研究院卒中量表(NIHSS)评分、高C-反应蛋白、高空腹血糖、高血肿体积、深部出血、合并脑室受累及蛛网膜下腔受累者发病90 d mRS评分更高(t/Z/H=-2.130、126.323、24.062、4.759、40.604、-3.377、-3.363、-3.266,P<0.05)。多重线性回归分析发现,CSVD总负荷评分、年龄、入院NIHSS评分、合并脑出血史、蛛网膜下腔受累与90 d mRS评分有相关性,且呈独立正相关(B=0.091、0.024、0.555、0.575、0.523,P<0.05)。结论CSVD总负荷评分与脑出血预后独立相关,提示潜在的CSVD可能影响脑出血患者功能恢复。

Objective To observe the correlation between the total burden score of cerebral small vessel disease(CSVD)and the prognosis of patients with cerebral hemorrhage.Methods A retrospective cohort study was conducted on 330 cases of spontaneous cerebral hemorrhage patients admitted to the department of neurology,Second Affiliated Hospital of Medical College of Zhejiang University from November 2017 to October 2019.The CSVD total burden score was calculated according to cerebral microbleeds(CMB),white matter hyperintensities(WMH),asymptomatic lacunar infarcts(LAC)and enlarged perivascular spaces(EPVS)evaluated by magnetic resonance imaging.The modified Rankin scale(mRS)score at 90 days after onset was collected as an indicator of prognosis.90-day mRS scores of patients with different clinical data characteristics were compared,and the correlation between CSVD total burden score and 90-day mRS score of cerebral hemorrhage patients was observed.Results Clinical data showed that patients with a history of cerebral hemorrhage,high admission National Institutes of Health Stroke Scale(NIHSS)score,elevated C-reactive protein,high fasting blood glucose,large hematoma volume,deep hematoma location,ventricular involvement and subarachnoid space involvement had poor prognosis(t/Z/H=-2.130,126.323,24.062,4.759,40.604,-3.377,-3.363,-3.266;P<0.05).Multiple linear regression analysis revealed that the CSVD total burden score,age,admission NIHSS score,history of cerebral hemorrhage and subarachnoid space involvement were correlated with the 90-day mRS score,and they were independently positively correlated(B=0.091,0.024,0.555,0.575,0.523;P<0.05).Conclusion The CSVD total burden score is independently correlated with the prognosis of cerebral hemorrhage,indicating a potential influence of underlying CSVD on the functional recovery of patients with cerebral hemorrhage.